4: central nervous system - airedale nhs foundation trust … · central nervous system formulary...

File name: Central Nervous System Formulary BNF Section 4

Original Date of issue: 26/11/2005 Last Reviewed:10/10/2012 Version:4 of 25

Department: Pharmacy Review Date:31/10/2014 Authorised: Drug and Therapeutics Committee

4: Central Nervous System 4.1 Hypnotics and anxiolytics

4.1.1 Hypnotics

Product Comments

Temazepam SF Solution (10mg/5ml) Temazepam Tablets (10mg)

CSM advice: 1. Benzodioazepines are indicated for the short term relief

(two to four weeks only) of anxiety that is severe, disabling or subjecting the individual to 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 and unsuitable

3. Benzodiazepines should be used to treat insomnia only when it is severe, disabling or subjecting the individual to extreme distress

Zolpidem Tablets (5mg) Zopiclone Tablets (3.75mg, 7.5mg)

Non benzodiazepine hypnotics that act at the benzodiazepine receptor. Licensed for short term treatment of insomnia

Formulary status

Product Restriction

R Nitrazepam Suspension (2.5mg/5ml) Nitrazepam Tablets (5mg)

Restricted to existing patients who come into hospital on it. See CSM advise above

R Chloral Hydrate Solution (500mg/5ml)

For inpatient use only. Any outpatient prescriptions or discharges should be checked with the paediatric pharmacist and discussions should include whether chrloal hydrate 143.3 mg/5ml (Welldorm) could be used instead as this is much more economical in the community.

4.1.2 Anxiolytics




Chlordiazepoxide Capsules (5mg, 10mg Diazepam Solution (2mg/5ml, 5mg/5ml) Diazepam Tablets (2mg, 5mg, 10mg) Lorazepam Injection (4mg/1ml) Lorazepam Tablets (1mg, 2.5mg) Oxazepam Tablets (10mg, 15mg)

Formulary status

Product Restriction

C Buspirone 5mg Tablets Consultant Psychiatrist use only for short term treatment of anxiety

4.2 Drugs used in psychoses and related disorders

4.2.1 Antipsychotic drugs

Chlorpromazine Syrup (25mg/5ml) Chlorpromazine Injection (50mg/2ml) Chlorpromazine Tablets (10mg, 25mg, 50mg, 100mg) Chlorpromazine Suppositories (100mg) Chlorpromazine Suspension (100mg/5ml) Flupentixol Tablets (3mg) Fluphenazine Tablets (1mg, 2.5mg) Haloperidol Injection (5mg/1ml) Haloperidol Capsules (500micrograms) Haloperidol Tablets (1.5mg, 5mg) Haloperidol SF Solution (5mg/5ml) Levomepromazine Tablets (25mg) Promazine Tablets (25mg) Promazine Syrup (25mg/5ml) Sulpiride SF Solution (200mg/5ml) Sulpiride Tablets (200mg, 400mg) Trifluoperazine MR capsules (2mg, 10mg,15mg) Trifluoperazine Tablets (1mg, 5mg) Trifluoperazine Syrup (1mg/5ml) Trifluoperazine Solution (5mg/5ml) Zuclopenthixol Tablets (2mg, 10mg, 25mg) Zuclopenthixol Injection (50mg/1ml, 100mg/2ml)

Formulary Product Restriction




status

C Benperidol Tablets (250micrograms)

Benperidol is used in treatment of deviant antisocial behavious but its value is not established. To be prescribed by Consultant Psychiatrists only

R Pimozide Tablets (4mg)

Reserved for existing patients only




Atypical antipsychotics

Formulary status

Product Restriction

C Amisulpride Tablets (50mg, 200mg, 100mg)

For Consultant Psychiatrist use only

C Amisulpride 500mg/5ml Solution For Consultant Psychiatrist use only

C Aripiprazole Tablets (5mg, 10mg, 15mg, 30mg)

For Consultant Psychiatrist use only.

C Clozapine Tablets (25mg, 100mg) Clozapine Liquid (100mg/5ml)

For Consultant Psychiatrist use only. Registration needed for all patients on this drug.

R Levomepromazine Tablets (25mg) Levomepromazine Injection (25mg/ml)

For Consultant Psychiatrist use and for palliative care

C Olanzapine Tablets (2.5mg, 5mg, 7.5mg, 10mg, 15mg)


C Olanzapine Orodispersible Tablets (5mg, 10mg, 15mg, 20mg)

For Consultant Psychiatrist use only For use only in patients with swallowing difficulites

C Olanzapine Injection (10mg) For Consultant Psychiatrist use only

C Quetiapine Starter Pack Quetiapine Tablets (25mg, 50mg, 100mg, 150mg, 200mg, 300mg) Quetiapine MR Tablets (200mg, 300mg)

For Consultant Psychiatrist use only Quetiapine MR tablets are much more expensive than the immediate release tablets

C Risperidone Liquid (5mg/5ml) For Consultant Psychiatrist use only

C Risperidone Tablets (500micrograms, 1mg, 2mg, 3mg)


C Risperidone Orodispersible Tablets (500micrograms, 1mg, 2mg, 3mg)

For Consultant Psychiatrist use only For use only in patients with swallowing difficulites

C Risperidone Injection (25mg, 37.5mg, 50mg)


4.2.2 Antipsychotic depot injections

Flupentixol Decanoate Injection (20mg/1ml, 40mg/2ml, 50mg/0.5ml, 100mg/1ml, 200mg/1ml)




Fluphenazine Decanoate Injection (100mg /1ml, 50mg/2ml, 25mg/ml, 50mg/0.5ml, 12.5mg/0.5ml) Haloperidol Decanoate Injection (100mg/1ml, 50mg/1ml) Pipotiazine Injection (50mg/1ml, 100mg/2ml) Zuclopenthixol Injection (200mg/1ml, 500mg/1ml)

4.2.3 Antimanic drugs

Product Comments

First line Lithium Carbonate M/R Tablets (200mg, 400mg) PRIADEL

Lithium carbonate 200mg = lithium citrate 509mg

Lithium Citrate syrup 509mg (5.4mmol) in 5ml PRIADEL

Others Lithium Carbonate M/R Tablets (250mg,400mg) CAMCOLIT

Reserved for patients who come in on it

Formulary status

Product Restriction

C Valproic acid as Semi Sodium Valproate Tablets (250mg, 500mg) Depakote

For Consultant Psychiatrist use only for the treatment of manic episodes associated with bipolar depression Should be prescribed by brand

4.3 Antidepressant drugs

4.3.1 Tricyclic and related antidepressant drugs Tricyclic and related antidepressants should be used with caution in patients with cardiovascular disease because of the risk of arrhythmias, patient with concomitant condtions such as hyperthyroidism and phaeochromocytoma should be treated witrh care. Care is also needed in patient with epilepsy and diabetes. Clomipramine Capsules (10mg, 25mg, 50mg) Clomipramine MR Tablets (75mg) Clomipramine Injection (25mg/2ml) Dosulepin Capsules (25mg) Doxepin Capsules (25mg, 50mg) Imipramine Tablets (10mg, 25mg) Lofepramine Tablets (70mg) Lofepramine SF Suspension (70mg/5ml) Nortriptyline Tablets (10mg, 25mg)




Trazodone Tablets (150mg) Trazodone Capsules (50mg, 100mg) Trazodone SF Liquid (50mg/5ml) Trimipramine Tablets (10mg, 25mg)




Formulary status

Product Restriction

R Amitriptyline SF Solution (25mg/5ml) Amitriptyline Tablets (10mg, 25mg, 50mg)

Reserved for patient who are admitted on them. Amitriptyline is not routinely recommended as as antidepressant but may be considered for neuropathic pain

R Dosulepin Oral Solution (25mg/5ml, 75mg/5ml) Dosulepin Tablets (75mg)

Reserved for patient who are admitted on them

R Mianserin Tablets (10mg, 20mg, 30mg)

Reserved for existing patients only

4.3.2 Monoamine-oxidase inhibitors Moclobemide Tablets (150mg, 300mg) Phenelzine Tablets (15mg)

4.3.3 Selective serotonin re-uptake inhibitors

Product Comments

First line Citalopram Oral Drops (40mg/1ml) Citalopram Tablets (10mg, 20mg, 40mg)

4 oral drops (8mg) is equivalent to a 10mg tablet Please express the dose on the oral drops as drops rather than milligrams. MHRA advice Citalopram and escitalopram are associated with dose dependent QT interval prolongation and should not be used in those with: congenital long QT syndrome; known pre-existing QT interval prolongation; or in combination with other medicines that prolong the QT interval. ECG measurements should be considered for patients with cardiac disease, and electrolyte disturbances should be corrected before treatment. For citalopram, new restrictions on the maximum daily dose apply: 40mg for adults; 20mg for patoient over 65years;




and 20mg for those with hepatic impairment.

Fluoxetine Capsules (20mg) Fluoxetine Liquid (20mg/5ml)

Second line

Paroxetine Tablets (10mg, 20mg, 30mg) Paroxetine SF Liquid (10mg/5ml) Sertraline Tablets (50mg, 100mg)

Formulary status

Product Restriction

C Escitalopram Tablets (10mg, 20mg) Consultant Psychiatrist use only MHRA advice Citalopram and escitalopram are associated with dose dependent QT interval prolongation and should not be used in those with: congenital long QT syndrome; known pre-existing QT interval prolongation; or in combination with other medicines that prolong the QT interval. ECG measurements should be considered for patients with cardiac disease, and electrolyte disturbances should be corrected before treatment. For escitalopram, the maximum daily dose for patients older than 65 years in now reduced to 10mg/day; other doses remain unchanged

C Escitalopram Oral Solution (10mg/ml)

4.3.4 Other antidepressant drugs Flupentixol Tablets (500micrograms, 1mg)

Formulary status

Product Restriction

C Duloxetine Capsules (30mg, 60mg) Consultant Psychiatrist use only Cymbalta brand only

C Mirtazapine Orodispersible Tablets (15mg, 30mg, 45mg)

Consultant Psychiatrist use only

C Reboxetine Tablets (4mg) Consultant Psychiatrist use only

C Venlafaxine Tablets (37.5mg, 75mg) Consultant Psychiatrist use only




C Venlafaxine M/R Capsules (75mg, 150mg)

Consultant Psychiatrist use only For use in patients who have already been stabilised on venlafaxine immediate release tablets

4.4 CNS stimulants and other drugs used for attention deficit hyperactivity disorder

Caffeine Citrate Solution (50mg/5ml)

Formulary status

Product Restriction

C Methylphenidate Tablets 10mg Methylphenidate Tablets MR 20mg

Consultant Psychiatrist and Paediatrician use only

C Modafinil Tablets (100mg) Restricted to Respiratory Consultant use only for the treatment of excessive daytime sleepiness associated with narcolepsy

4.5 Drugs used in the treatment of obesity

4.5.1 Anti-obesity drugs acting on the gastro-intestinal tract

NIL

Formulary status

Product Restriction

R Orlistat Capsules (120mg) Available for patients who come in on it who are being treated according to NICE CG243

4.5.2 Centrally acting appetite suppressants

http://guidance.nice.org.uk/CG43





4.6 Drugs used in nausea and vertigo Link to: Nausea and Vomiting (Postoperative) Management Guideline

Product Comments

First line Dexamethasone tabolets 8mg

Ondansetron tablets (4mg) Ondansetron injection (4mg in 2ml) Ondansetron syrup (4mg in 5ml)

For use within its licensed indication in accordance with protocol.

Prochlorperazine Injection (12.5mg/1ml) Prochlorperazine Tablets (5mg) Prochlorperazine Buccal Tablets 3mg Prochlorperazine Syrup (5mg/5ml)

Second line

Cyclizine Tablets (50mg) Cyclizine Injection (50mg/ml) Cyclizine Liquid (25mg/5ml)

Cyclizine is an antihistamine. Dose should be reduced in elderly as it can cause drowsiness

Metoclopramide Syrup (5mg/5ml) Metoclopramide Injection (10mg/2ml) Metoclopramide Tablets (10mg)

Least effective antiemetic but it can relieve full feeling in stomach Extra pyramidal side effects e.g. tremor/dystonia and abnormal eye movements can be reversed with 5-10 mg procyclidine given IM or IV (2.5mg-5mg in elderly)

Third line Domperidone SF Suspension (5mg/5ml) Domperidone Suppositories (30mg) Domperidone Tablets (10mg)

May be administered rectally. Less likely to give rise to sedation and abnormal facial and eye movements

Droperidol injection 2.5mg/ml Consultant Anaesthetist use only for the prevention and treatment of PONV in adult patients in whom other IV antiemetics are ineffective or contraindicated.

http://sharepoint-srv2/C10/Clinical%20Guidelines/Compiling%20a%20Guideline/Post%20Operative%20Nausea%20and%20Vomiting%20(PONV)%202012.docm

http://sharepoint-srv2/C10/Clinical%20Guidelines/Compiling%20a%20Guideline/Post%20Operative%20Nausea%20and%20Vomiting%20(PONV)%202012.docm




Formulary status

Product Restriction

R Aprepitant 3 day pack Capsules (80mg+125mg)

Use supported for during 2nd and subsequent cycles of cisplatin-based chemotherapy for patients who have had intractable N&V during 1st cycle despite having 5HT3 antagonist.

C Ondansetron Tablet (8mg) Ondansetron Injection (8mg/4ml) Dexamethasone sodium phosphate injection 8mg in 2ml Dexamethasone tablets 2mg

Prescribed by Consultant Haematologist and Oncologist for prevention of nausea and vomiting induced by highly emetogenic chemotherapy

R Levomepromazine Injection 25mg/ml

For palliative care use only

R Levomepromazine Tablets 25mg For palliative care use and for Consultant Psychiatrist use only

Motion sickness Betahistine Tablets (8mg) Cinnarizine Tabets (15mg) Hyoscine hydrobromide (Kwells Tablets) Promethazine theoclate Tablets (25mg)

Formulary status

Product Restriction

R Hyoscine hydrobromide Patch (1.5mg) (1mg in 72hrs)

Reserved for prevention of excessive salivation and reduction of secretions

R Hyoscine hydrobromide injection 400micrograms / ml

See BNF 15.1.3

C Glycopyrronium bromide tablets (1mg )

For use by Community Paediatricians. Reserved for prevention of excessive salivation and reduction of secretions in patients who cannot tolerate or who do not respond to hyoscine patches. Unlicensed product paperwork required




4.7 Analgesics (Needs to link to pain ladder) Link to Musculoskeletal section for NSAID’s

4.7.1 Non-opioid analgesics

Product Comments

First line Paracetamol Caplets (500mg) Paracetamol Tablets (500mg) Paracetamol Suspension (120mg/5ml, 250mg/5ml) Paracetamol Suppositories (60mg, 120mg, 240mg, 500mg) Paracetamol Tablet Soluble (500mg)

Link to analgesic table

Formulary status

Product Restriction

R Paracetamol Infusion (1g/100ml)

Reserved for use in adults, adolescents and children weighing more than 33kg:

1. who have undergone bowel surgery

2. with moderate pain who are unable to take oral analgesia, who already have an IV running and where rectal paracetamol is inappropriate.

R Paracetamol Infusion (500mg/50ml)

Reserved for use in term newborn infants, infants, toddlers and children weighing less than 33kg:

1. who have undergone bowel surgery

2. with moderate pain who are unable to take oral analgesia, who already have an IV running and where rectal paracetamol is inappropriate.

R Nefopam Tablets (30mg) For psychiatric wards only

Aspirin Tablets Dispersible (300mg) Aspirin Tablets EC (300mg) Aspirin Suppositories (150mg, 300mg)




4.7.2 Opioid analgesics 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.

Product Comments

Co-dydramol 10/500 Tablets (paracetamol 500mg with dihydrocodeine 10mg)

Please use the analgesic ladder as a guide to the treatment of pain. Try to avoid the use of these products as they are not included on the analgesic ladder.

Co-codamol 8/500 Tablets (paracetamol 500mg, codeine phosphate 8mg) Co-codamol 8/500 Effervescent Tablets (paracetamol 500mg, codeine phosphate 8mg)

Stronger opioids First line Co-codamol Tablets 30/500 (paracetamol

500mg, codeine phosphate 30mg) Codeine Phosphate Tablets (15mg, 30mg, 60mg) Codeine Phosphate Injection (60mg/ml) Codeine Phosphate Syrup (25mg/5ml) Dihydrocodeine Solution (10mg/5ml) Dihydrocodeine Tablets (30mg) Dihydrocodeine Injection (50mg/1ml)

Link to analgesic ladder

Morphine Sulphate MR Tablets (5mg, 10mg, 15mg, 30mg, 60mg, 100mg, 200mg)

Please ensure that the brand of sustained release morphine is stated on the discharge letter to GP’s

Morphine Sulphate oral Solution (10mg/5ml, 100mg/5ml) Morphine Sulphate Injection (10mg/1ml, 1mg/ml) Morphine Sulphate Intrathecal Injection (2mg/2ml) Morphine Syringes 50mg/50ml Morphine Injection (50mg/50ml) Morphine Sulphate MR Sachets (20mg, 30mg) Tramadol Capsules 50mg




Buprenorphine patches 5mcg/hr – BuTrans 10mcg/hr – BuTrans 20mcg/hr – BuTrans 35mcg/hr – Transtec 52.5mcg/hr – Transtec 70mcg/hr - Transtec

Not to be used in opioid naïve patients. 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. For the BuTrans products, the release is over a 7 day period. For the Transtec products, the release is over a 4 day period.

Formulary status

Product Restriction

R Alfentanil Injection 1mg/2ml Alfentanil Injection 5mg/10ml

For theatre and ICU use only.

R Alfentanil Nasal Spray 5mg/5ml

For Palliative Care Consultant’s use only

R Alfentanil Injection 5mg/1ml For Palliative Care Consultant’s use only and ICU

R Buprenorphine Sublingual Tablets (200micrograms, 400micrograms, 2mg, 8mg) Buprenorphine Injection (300mcg/ml)

S 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,

Palliative care (only for patient who have come in and are established on diamorphine - used routinely at Harden ward CBH (North Yorkshire PCT) for palliative care syringes, initiated by GPs)

S Diamorphine Injection (10mg, 30mg, 100mg, 500mg)

For aseptic use only for preparation of diamorphine syringes




Formulary status

Product Restriction

R Dihydrocodeine M/R Tablets (60mg, 90mg, 120mg)

For use in chronic pain states only

R Fentanyl Patches (12micrograms, 25micrograms, 50micrograms, 75micrograms, 100micrograms)

Palliative care use or under recommendation by the pain team Please ensure that the brand prescribed is written on the dischsarge prescription Not to be used in opioid naïve patients.

R Fentanyl (Abstral) Sublingual Tablets (S/L) (100mcg, 200mcg, 300mcg, 400mcg)

For the treatment of breakthrough cancer pain in patients in whom standard treatments (morphine or oxycodone) are ineffective or not tolerated

C Hydromorphone Capsules (1.3mg, 2.6mg)

Under Palliative Care Consultant’s recommendations for patients intolerant of morphine

C Hydromorphone M/R Capsules (2mg, 4mg, 8mg, 16mg, 24mg)


C Hydromorphone Injection (10mg/1ml, 50mg/1ml)


S Morphine Sulphate Injection (15mg/1ml,30mg/1ml, 60mg/10ml)

Aseptics use only

R Oxycodone Hydrochloride Injection (20mg/2ml, 10mg/1ml)

For Palliative Care use only

C Oxycodone capsules (5mg, 10mg, 20mg) Oxycodone m/r tablets (5mg, 10mg, 20mg, 40mg, 80mg) Oxcodone Liquid (50mg/5ml) Oxcodone SF Liquid (5mg/5ml)

For use by Palliative Care Consultants or

Second-line after morphine for patients developing intolerable side effects with morphine

R Pethidine Injection (100mg/2ml, 50mg/1ml)

Reserved for obstetric use only

R Papaveretum Injection 15.4mg/ml Papaveretum Injection 7.7mg/ml

Unsuitable for women of childbearing age

R Syrup BP (66.7%) 50ml For neonatal use only




Formulary status

Product Restriction

R Tramadol MR Tablets (100mg) Tramadol Soluble Tablets (50mg) Tramadol MR Capsules (50mg) Tramadol Injection (100mg/2ml)

Tramadol can be used as an alternative to dihydrocodeine or codeine in patient with uncontrolled acute or chronic pain or where side effects of codeine/dihydrocodeine are a problem. The sustained release preparations should not be used for acute pain.




4.7.3 Neuropathic and functional pain Refer to BNF for products. NICE Clinical Guideline CG96 Neuropathic pain – pharmacological management Gabapentin Capsules (100mg, 300mg, 400mg)

Formulary status

Product Restriction

C Pregabalin Capsules (25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 300mg)

For use by Diabetic team for the treatment of diabetic neuropathy (as an alternative to gabapentin and following a trial of a tricyclic drug). For the treatment of neuropathic back pain in patients in whom gabapentin and tricyclics have been ineffective or not tolerated.

4.7.4 Antimigraine drugs 4.7.4.1 Treatment of the acute migraine attack Treatment of a migraine attack should be guided by response to previous treatment and the severity of the attacks. A simple analgesic such as aspirin, paracetamol (preferably in a soluble or dispersible form) or an NSAID is often effective; concomitant antiemetic treatment may be required. If treatment with an analgesic is inadequate, an attack may be treated with a specific antimigraine compound such as a 5HT1 agonist (triptan)

Analgesics

Aspirin see Section 4.7.1

Paracetamol see Section 4.7.1

Non Steroidal Antiinflammatory Drugs see Section 10.1.1

5HT1 agonists Sumatriptan Tablets (50mg, 100mg) Sumatriptan Nasal Spray (10mg/0.1ml, 20mg/0.1ml) Sumatriptan Syringe plus autoinjectors (6mg/0.5ml) Sumatriptan Syringe Refill (6mg/0.5ml)

http://www.nice.org.uk/nicemedia/live/12948/58253/58253.pdf

http://www.nice.org.uk/nicemedia/live/12948/58253/58253.pdf




4.7.4.2 Prophylaxis of migraine Pizotifen Tablets (500micrograms, 1.5mg) Pizotifen Elixir (250micrograms/5ml) See BNF for other treatments

4.8 Antiepileptics 4.8.1 Control of epilepsy

Antiepileptics should be prescribed by brand Carbamazepine SF Liquid (100mg/5ml) Carbamazepine chewable Tablets (100mg, 200mg) Carbamazepine Tablets (100mg, 200mg) Carbamazepine MR Tablets (200mg, 400mg) Carbamazepine Suppositories (125mg, 250mg) Clobazam Tablets (10mg) Clonazepam SF Solution (500micrograms/5ml) Clonazepam Tablets (500micrograms, 2mg) Clonazepam injection 1mg/1ml Ethosuximide Capsules (250mg) Ethosuximide Syrup (250mg/5ml) Lamotrigine Tablets (25mg, 50mg, 100mg, 250mg) Lamotrigine Dispersible Tablets (5mg, 25mg, 100mg) Lamotrigine (Lamictal) Cewable/ Dispersible Tablets (2mg) Levetiracetam Tablets (250mg, 500mg, 1000mg) Levetiracetam Oral Solution (100mg/ml) Levetiracetam Infusion (100mg/ml) Phenobarbital Tablets (15mg, 30mg, 60mg) Phenobarbital Injection (60mg/1ml, 200mg/ml) Phenobarbital Mixture (15mg/5ml, 50mg/5ml) Phenytoin Injection (250mg/5ml) Phenytoin Suspension (30mg in 5ml) Phenytoin Sodium Injection (250mg/5ml) Phenytoin Sodium Capsules (25mg, 50mg, 100mg) Phenytoin Sodium Tablets (50mg, 100mg) Primidone Tablets (250mg) Sodium Valproate (Epilim) SF Liquid (200mg/5ml) Sodium Valproate (Orlept) SF Liquid (200mg/5ml) Sodium Valproate (Epilim) Injection (400mg) Sodium Valproate (Episenta) Injection (300mg/3ml)




Sodium Valproate (Epilim) EC Tablets (200mg, 500mg) Sodium Valproate (Orlept) EC Tablets (500mg) Sodium Valproate (Epilim Chrono) MR Tablets (200mg, 300mg, 500mg) Sodium Valproate (Episenta) MR Capsules (150mg, 300mg) Sodium Valproate (Episenta) MR Sachets (1g, 500mg) Sodium Valproate (Epilim) CrushableTablets (100mg) Sodium Valproate (Epilim) Syrup (200mg/5ml) Vigabatrin Tablets (500mg) Vigabatrin Sachets (500mg)

Formulary status

Product Restriction

C Topiramate Tablets (25mg, 50mg, 100mg, 200mg) Topiramate Sprinkle Caspules (15mg, 25mg)

Consultant Neurologist use only

S Gabapentin Capsules (100mg, 300mg, 400mg)

Specailist departmental use only

4.8.2 Drugs used in status epilepticus Clonazepam Injection (1mg/1ml) Diazepam Emulsion Injection (10mg/2ml) Diazepam Injection (10mg/2ml) Diazepam Rectal Tubes (2.5mg, 5mg, 10mg) Lorazepam Injection (4mg/1ml) Paraldehyde Injection (5ml) Paraldehyde/ Olive Oil Enema 50% (10ml)

Formulary status

Product Restriction

C Buccolam Midazolam Oromucosal Solution 5mg/ml: 0.5ml (2.5mg) prefilled syringes 1ml (5mg) prefilled syringes 1.5ml (7.5mg) prefilled syringes 2ml (10mg) prefilled syringes Please note Schedule 3 CD and is subject to special prescription requirements and to safe custody requirements.

For Consultant Paediatrician use in the community setting as an alternative to rectal diazepam for status epilepticus. For use in A&E as an alternative to rectal diazepam for status epilepticus for children and adolescents. For use by the palliative care team as an alternative to rectal diazepam for patients dying at home. For supply to Dental Clinics for use in case of medical emergency Please note this is a different strength to the unlicensed product.




Although records in registers do not need to be kept we have decided at ANHSFT that we will keep a CD register for these both in pharmacy and on the wards where it is stocked (A&E and ward 17)

It should be prescribed by the brand name with the dose in mLs and mgs. Dose by buccal adminisatration: Adult over 18 [unlicensed], 10mg repeated once after 10minutes if necessary Child up to 6 months [unlicensed], 300micrograms/kg (max 2.5mg), 6months -1year 2.5mg, 1- 5 years 5mg, 5 – 10 years 7.5mg, 10-18 years 10mg; these doses may be repeated once after 10minutes if necessary

C Epistatus Midazolam Buccal liquid (10mg/1ml) 4ml bottle with measuring syringes provided.

This is an unlicensed preparation and requires the unlicensed medicines paperwork filling in by the consultant. It should only be used if the doses available in the licensed preparation are not appropriate. Please note this is a different strength to the licensed product. It should be prescribed by the brand name with the dose in mLs and mgs.

4.9 Drugs used in parkinsonism and related disorders

4.9.1 Dopaminergic drugs used in parkinsonism

Dopamine receptor agonists Co-beneldopa Capsules (12.5/50, 25/100) Co-beneldopa MR Capsules (25/100) Co-beneldopa Dispersible Tablets (12.5/50, 25/100) Co-careldopa Tablets (12.5/50, 25/100, 10/100, 25/250) Co-careldopa MR Tablets (25/100, 50/200)

Formulary status

Product Restriction

R Apomorphine Pens (30mg/3ml, 50mg/10ml) Consultant Neurologist and Department of Elderly Medicine




Physician use only

R Pramipexole tablets 88micrograms base = 125micrograms salt 180micrograms base = 250micrograms salt 350micrograms base = 500micrograms salt 700micrograms base = 1mg salt

Consultant Neurologist and Department of Elderly Medicine Physician use only. Reserved for patients WITH

Parkinson’s disease who have not responsed to or who are intolerant of ropinirole.

Moderate to severe restless leg syndrome

C Ropinirole Tablets (250mcg, 1mg, 2mg, 3mg, 5mg) Ropinirole SR tablets (2mg, 4mg, 8mg) Ropinirole Starter Pack

Consultant Neurologist and Department of Elderly Medicine Physician use only

R Rotigotine transdermal patches (2mg, 4mg, 6mg, 8mg/24h)

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

Monoamine-oxidase-B inhibitors Selegiline Tablets (5mg) Selegiline Liquid (10mg/5ml)

Formulary status

Product Restriction

C Rasagiline tablets 1mg Consultant Neurologist and Department of Elderly Medicine Physician use only. For patients intolerant of selegiline or who are likely to develop psychotic side effects or sleep disturbances as a result of treatment

Catechol-O-methyltransferase inhibitors

Formulary status

Product Restriction

S Entacapone tablets 200mg For specialist initiation only

Glutamate inhibitors

Formulary status

Product Restriction

C Amantadine capsules 100mg For use by Consultant Neurologist and Department of Elderly Medicine Physicians




in-line with NICE CG35

Combination Products

Formulary status

Product Restriction

R Stalevo tablets (Co-careldopa + entacapone) (50mg/12.5mg/200mg, 75mg/18.75mg/200mg, 100mg/25mg/200mg, 150mg/37.5mg/200mg, 200mg/50mg/200mg)

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

4.9.2 Antimuscarinic drugs used in parkinsonism Orphenadrine Elixir (25mg/5ml) Orphenadrine Tablets (50mg) Procyclidine Tablets (5mg) Procyclidine Injection (10mg/2ml) Procyclidine SF Syrup (5mg/5ml) Trihexyphenidyl Syrup (5mg/5ml) Trihexyphenidyl Tablets (2mg, 5mg)

4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders

Tetrabenazine Tablets (25mg)

Formulary status

Product Restriction

C Botulinum A Toxin 100unit vial (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 Dysport units.





C Botulinum A Toxin 100units vial (Xeomin Injection)

Consultant in Rehab Medicine has agreed to use this brand for her patients if clinically appropriate. Xeomin units are considered to be equivalent to Botox units

C Botulinum B Toxin 2,500units in 0.5ml (Neurobloc Injection)

For use by Consultant Neurologist in patients who have been transeferred from Leeds back to ANHSFT

C Riluzole tablets (50mg) Consultant Neurologist use only. For patients with AML form of motor neurone disease




4.10 Drugs used in substance dependence Buprenorphine Tablets (Subutex) (2mg, 8mg)

Nicotine patches Nicorette inhalator 10mg refill Nicorette inhalator Starter Pack Nicotinell 1mg lozenges Niquitin CQ 7mg patches (24 hour) Niquitin CQ 14mg patches (24 hour) Niquitin CQ 21mg patches (24 hour) Niquitin Minis lozenges 1.5mg, 4mg

Formulary status

Product Restriction

C Acamprosate E/C Tablets (333mg)

Consultant Psychiatrist use only

R Methadone Mixture (1mg/1ml) Methadone SF Mixture (1mg/1ml) Methadone Tablets (5mg) Methadone Injection (10mg/1ml)

Restricted for treatment of opioid addiction

R Nicorette 2mg gum Initiated by smoking cessation nurse.

R Niquitin CQ Lozenges (2mg, 4mg)

Initiated by smoking cessation nurse.

R Varenicline Tablets (0.5mg, 1mg)

Initiated by smoking cessation nurse or for existing patients. For use in-line with NICE TA123 (July 2007)

R Varenicline Tablets Initiation Pack

Initiated by smoking cessation nurse. For use in-line with NICE TA123 (July 2007)

http://www.nice.org.uk/guidance/TA123





4.11 Drugs for dementia

Formulary status

Product Restriction

C Donepezil Tablets (5mg, 10mg) Donepezil orodispersible Tablets (10mg)

For treatment of moderate Alzheimer’s disease. Consultant Psychiatrist and Department of Elderly Medicine Physician use only. For use in-line with NICE TA217 (March 2011).

R Galantamine Solution (4mg/ml) Galantamine Tablets (8mg)

Restricted for BDCT, 8mg must not be halved, 4mg doses use solution. For use in-line with NICE TA217 (March 2011).

R Memantine Tablets 10mg For use in-line with NICE TA217 (March 2011).

R Rivastigmine Capsules 1.5mg, 3mg, 4.5mg, 6mg Rivastigmine oral solution (2mg/ml) Rivastigmine transdermal patches (4.6mg/24hrs, 9.5mg/24hrs)

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 patients who come in on it. For use in-line with NICE TA217 (March 2011).





4: central nervous system - airedale nhs foundation trust … · central nervous system formulary...

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