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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.01  Hypnotics and anxiolytics
04.01.01  Hypnotics
 note 

First line options include non-pharmacological approaches including introducing 'sleep hygiene' measures and advice on relaxation techniques.

Melatonin  (Circadin®)
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*Circadin® brand should be used in most circumstances*

Amber Traffic Light  For sleep disorders in children and young people with complex neurological / neurodevelopmental disorders (age 1-18years) in line with Shared Care Protocol. Tablets may be crushed or halved but this will destroy the MR properties.

Also see Clinical Commissioning Policy 274

APCO September 2016.

Red Traffic Light  Specialist prescribing only for sleep EEG.

APCO January 2012.

Red Traffic Light  Specialist prescribing within Oxford Mental Health for children and adolescents.

APCO January 2012.

Black Traffic Light  For jet lag, primary insomnia, circadian rhythm sleep disorder.

APCO July 2008 and January 2012.

 
Link  NICE Evidence summary: Melatonin for sleep disorders in children with ADHD
Link  Medicines for Children leaflet: Melatonin for sleep disorders
   
04.01.01  Benzodiazepines
Controlled Drug Temazepam
(Hypnotic)
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Formulary
Green

Prescribe in line with local guidelines on managing insomnia.

APCO November 2018.

 
   
Nitrazepam
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Restricted Drug Restricted
Brown

For established patients only.

Long-acting so risk of accumulation. Avoid use in the elderly. 

 
   
04.01.01  Zaleplon, Zolpidem and Zopiclone
Zopiclone
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Formulary
Green

Prescribe in line with local guidelines on managing insomnia.

APCO November 2018.

 
Link  NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
   
Zolpidem
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Formulary
Red

To be prescribed at Oxford Health NHS Foundation Trust only.

 
Link  NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
Link  MHRA: Zolpidem - risk of drowsiness and reduced driving ability
   
04.01.01  Chloral and derivatives to top
Chloral Hydrate
(Oral solution)
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Formulary
Red

Secondary care use only. 

 
   
Triclofos Sodium (Triclofos® Elixir)
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Red

For use by paediatric neurologists prior to EEG only.

APCO May 2004.

 
   
04.01.01  Clomethiazole (Chlormethiazole)
Clomethiazole (Heminevrin®)
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Formulary
Red

Secondary care use only. 

 
   
04.01.01  Antihistamines
Promethazine Hydrochloride
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Green
 
   
04.01.01  Alcohol
04.01.01  Sodium oxybate
Controlled Drug Sodium Oxybate (Xyrem®)
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High Cost Medicine

Red Traffic Light  For narcolepsy in children. 

Funded by specialised commissioning.

APCO July 2017.

Black Traffic Light  Not recommended for cataplexy.

APCO June 2007.

For use by Consultant Neurologists only following an IFR approval from OCCG. Prescription must be on sodium oxybate-specific form. 

 
   
04.01.02  Anxiolytics to top
Pregabalin
(Anxiety)
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Formulary
Green

Third line option when an SSRI and SNRI is contraindicated for Generalised Anxiety Disorder. See Primary Care Generalised Anxiety Disorder Guideline for Adults and Older Adults.

APCO September 2017.

 
   
04.01.02  Benzodiazepines
Diazepam
(Anxiety)
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Formulary
Green
 
   
Lorazepam
(Anxiety)
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Green
 
   
Chlordiazepoxide
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Amber Continuation

For the treatment of Acute Alcohol Withdrawal. Suitable for continuation in primary care following specialist recommendation.

 
   
04.01.02  Buspirone
Buspirone Hydrochloride
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Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation for Generalised Anxiety Disorder. See Primary Care Generalised Anxiety Disorder Guideline for Adults and Older Adults.

APCO September 2017.

NB. Buspiron is not available at the OUH Trust.

 
   
04.01.02  Beta blockers
Propranolol
(Anxiety)
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Formulary
Green

Propranolol is only helpful for the physical symptoms of anxiety (e.g. sweating, tachycardia and tremor). In GAD with lots of worry, propranolol may not be indicated.

See Primary Care Generalised Anxiety Disorder Guideline for Adults and Older Adults.

 
   
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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Formulary
Amber Continuation

Suitable for continuation in primary care following specialist recommendation.

 
   
Clozapine
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Formulary
Amber Shared Care Protocol

In line with Shared Care Protocol for the treatment of:

    • Resistant schizophrenia (lack of satisfactory response) and in schizophrenia patients who have severe, untreatable neurological adverse reactions to other antipsychotic agents, including atypical antipsychotics
    • Resistant psychosis in Parkinson’s Disease.

See Treatment of psychosis and schizophrenia algorithm

APCO January 2011.

 
Link  Patient Information Leaflet: Handy fact sheet - Clozapine and Smoking
   
Flupentixol (Depixol®)
(Antipsychotic)
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Amber Continuation

Suitable for continuation in primary care following specialist recommendation.

 
   
Haloperidol
(Oral)
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Amber Continuation

Suitable for continuation in primary care following specialist recommendation.

Oral and IM doses are NOT equivalent. 

 
   
Levomepromazine
(Tablets)
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Amber Traffic Light  Suitable for continuation in primary care following specialist recommendation.

Green Traffic Light  For palliative care use.

 
   
Sulpiride
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Amber Traffic Light  Suitable for continuation in primary care following specialist recommendation in line with Treatment of psychosis and schizophrenia algorithm

Brown Traffic Light  Second-line (off license use) for short term use in line with Antipsychotic Use for Behavioural and Psychiatric Symptoms of Dementia Prescribing Guidance. Prescribing Points October 2011. For details please email OCCG.medicines@nhs.net

APCO September 2011.

 
   
Trifluoperazine
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Amber Continuation

Suitable for continuation in primary care following specialist recommendation.

 
   
Zuclopenthixol (Clopixol®)
(Tablets)
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Amber Continuation

Suitable for continuation in primary care following specialist recommendation.

 
   
Zuclopenthixol Acetate (Clopixol Acuphase®)
(Injection)
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Red

To be used under the direction of consultant psychiatrist, in line with Treatment of psychosis and schizophrenia algorithm. Not for neuroleptic naive patients.

Do not confuse with zuclopenthixol decanoate the long-acting depot injection preparation.

APCO May 2014.

 
   
Haloperidol
(Intramuscular)
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Red Traffic Light  For rapid tranquilisation: Hospital use only.

Green Traffic Light  For use in palliative care

 
   
04.02.01  Second-Generation Antipsychotic Drugs
Risperidone
(Oral)
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First Choice

Amber Traffic Light  First choice treatment in psychosis and schizophrenia. Suitable for continuation in primary care following specialist recommendation in line with Treatment of psychosis and schizophrenia algorithm

Restricted Item Brown Traffic Light  First-line (off license use) for the treatment of psychosis or for persistent aggression in dementia in line with Antipsychotic Use for Behavioural and Psychiatric Symptoms of Dementia Prescribing Guidance. Prescribing Points October 2011. For details please email OCCG.medicines@nhs.net

APCO September 2011.

 
Aripiprazole
(Orodispersible)
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Amber Continuation

Only if recommended by secondary care in patients with swallowing difficulty or where supervised consumption is needed.

APCO November 2006.

 
   
Amisulpride
(Oral)
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Amber Traffic Light Suitable for continuation in primary care following specialist recommendation in line with Treatment of psychosis and schizophrenia algorithm

Restricted Item Brown Traffic Light  Second-line (off license use) for short term use in line with Antipsychotic Use for Behavioural and Psychiatric Symptoms of Dementia Prescribing Guidance. Prescribing Points October 2011. For details please email OCCG.medicines@nhs.net

APCO September 2011.

 
   
Aripiprazole
(Tablet)
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Red Traffic Light  For moderate to severe manic episodes in adolescents with bipolar disorder.

APCO September 2013.

Amber Traffic Light Suitable for continuation in primary care following specialist initiation for schizophrenia in people aged 15 to 17 years.

APCO May 2011.

Amber Traffic Light  Suitable for continuation in primary care following specialist recommendation in line with Treatment of psychosis and schizophrenia algorithm

APCO September 2004.

Restricted Item Brown Traffic Light  Second-line (off license use) for short term use in line with Antipsychotic Use for Behavioural and Psychiatric Symptoms of Dementia Prescribing Guidance. Prescribing Points October 2011. For details please email OCCG.medicines@nhs.net

APCO September 2011.

 
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
Link  NICE TA292: Bipolar disorder (children) - aripiprazole
   
Aripiprazole
(Short acting IM injection)
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Red

For secondary care psychiatrist prescribing only, in line with Treatment of psychosis and schizophrenia algorithm

 
   
Cariprazine
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Red

Secondary care use only. 

 
   
Loxapine  (Adasuve®)
(Inhalation powder)
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Formulary
Red

For prescribing by Mental Health Specialists only.

APCO September 2017.

 
   
Lurasidone
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Formulary
Red

For schizophrenia.

Lurasidone is OFF-LABEL for bipolar depression. Any OH prescriber wishing to use lurasidone for this indication should complete an off-label request form and send it to the Drugs and Therapeutics Group (dtc@oxfordhealth.nhs.uk).

See Treatment of psychosis and schizophrenia algorithm

APCO March 2015.

 
   
Olanzapine
(Oral)
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Amber Traffic Light  Suitable for continuation in primary care following specialist recommendation in line with Treatment of psychosis and schizophrenia algorithm.

Restricted Item Brown Traffic Light  Second-line (off license use) for short term use in line with Antipsychotic Use for Behavioural and Psychiatric Symptoms of Dementia Prescribing Guidance. Prescribing Points October 2011. For details please email OCCG.medicines@nhs.net

APCO September 2011.

 
   
Olanzapine Oral lyophilisate (Zyprexa® Velotabs)
(Oral)
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Restricted Drug Restricted
Brown

ORODISPERSIBLE TABLETS are restricted for palliative or end of life care patients with swallowing difficulties and for patients with feeding tubes only.

 
   
Quetiapine  (Standard-release)
(Oral)
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Amber Traffic Light  Suitable for continuation in primary care following specialist recommendation in line with Treatment of psychosis and schizophrenia algorithm

Restricted Item Brown Traffic Light  Second-line (off license use) for short term use in line with Antipsychotic Use for Behavioural and Psychiatric Symptoms of Dementia Prescribing Guidance. Prescribing Points October 2011. For details please email OCCG.medicines@nhs.net

APCO September 2011.

Black Traffic Light  For generalised anxiety disorder due to limited evidence suggesting no greater efficacy than antidepressants.

APCO July 2013.

 
Link  NICE Evidence summary: Quetiapine for generalised anxiety disorder
   
Quetiapine XL (Modified-release)
(Oral)
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Red

Used in secondary care to initiate treatment. Secondary care will switch to standard release preparation following titration and prior to discharge to primary care.

No clinical evidence of increased tolerability compared to immediate release therapy. Licensing for immediate release and modified release same. Only anecdotal evidence of benefit in titration.

APCO July 2013.

 
Link  NICE Evidence summary: Quetiapine for generalised anxiety disorder
   
Sertindole (Serdolect®)
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Red

Named patient drug. Specialist prescribing only.

 
   
Olanzapine
(Short-acting injection)
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Unlicensed Drug Unlicensed
Red

Specialist prescribing only in line with Treatment of psychosis and schizophrenia algorithm

Olanzapine IM is not licensed in the UK. Unlicensed preparations are available.

 
   
04.02.02  Antipsychotic depot injections
Zuclopenthixol Decanoate (Clopixol®)
(Injection)
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Amber Continuation

Suitable for continuation in primary care following specialist initiation. See Treatment of psychosis and schizophrenia algorithm

This preparation is used for maintenance treatment and should not be used for the short-term management of an acute episode.

APCO July 2013.

 
   
Flupentixol Decanoate (Depixol®)
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Amber Continuation

Suitable for continuation in primary care following specialist initiation. 

 
   
Fluphenazine Decanoate (Modecate®)
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Amber Continuation

*Product discontinued*

Suitable for continuation in primary care following specialist initiation. 

Fluphenazine depot is discontinued existing stocks will expire in August 2019 (25mg/ml) and August 2020 (100mg/ml).

** Please do not start any new patients on fluphenazine depot **

All patients currently receiving fluphenazine depot should be reviewed at the earliest opportunity so that an arrangements can be made to switch to an alternative antipsychotic treatment.

 

 
   
Haloperidol (Haldol Decanoate®)
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Amber Continuation

Suitable for continuation in primary care following specialist initiation.

This preparation is used for maintenance treatment and should not be used for the rapid control of an acute episode.

 
   
Olanzapine Embonate (ZypAdhera®)
(Depot injection)
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Red

Olanzapine long acting injection (OLAI) is not routinely available in OH. Exceptional requests to use OLAI are reviewed by the Trust's Drugs & Therapeutics Group on a case by case basis. Must be administered in a healthcare setting.

See Treatment of psychosis and schizophrenia algorithm.

APCO July 2013.

 
   
Paliperidone (Trevicta®)
(Long acting injection)
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Red

Secondary care use only. Prescribe by brand. 

3 monthly.

 
Link  MHRA: Risk of intraoperative floppy iris syndrome in people undergoing cataract surgery
   
Paliperidone (Xeplion®)
(Long Acting Injection)
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Red

Specialist prescribing only, in line with Treatment of psychosis and schizophrenia algorithm.

Secondary care use only. Prescribe by brand. 

1 monthly.

 
Link  MHRA: Risk of intraoperative floppy iris syndrome in people undergoing cataract surgery
   
Risperidone (Risperdal Consta®)
(Long acting injection)
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Red

Specialist prescribing only, in line with Treatment of psychosis and schizophrenia algorithm.

 
Link  MHRA: Risk of intraoperative floppy iris syndrome in people undergoing cataract surgery
   
Aripiprazole (Abilify Maintena®)
(Long Acting Injection)
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Formulary
Red

Secondary care psychiatrist prescribing only, in line with Treatment of psychosis and schizophrenia algorithm

APCO July 2013.

 
   
04.02.03  Drugs used for mania and hypomania to top
Lamotrigine
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Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation for bipolar disorder.

Patients stabilised on lamotrigine for bipolar disorder may require dose adjustments if other drugs are added to or withdrawn from their treatment regimens.

 
   
Asenapine
(Sycrest)
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Red

Specialist prescribing only.

 
   
04.02.03  Benzodiazepines
Clonazepam
(Mania)
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Amber Continuation

Specialist initiation only for the initial management of agitated or disturbed behaviour associated with mania, but should not be used long-term.

Available orally only as a 500 microgram tablet and a 2mg tablet (IM injection no longer manufactured in the UK).

 
   
04.02.03  Antipsychotic drugs
04.02.03  Carbamazepine
Carbamazepine
(Mania)
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Formulary
Amber Continuation

Suitable for continuation in primary care following specialist recommendation.

 
   
04.02.03  Valproic acid
Sodium valproate
(Mania)
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First Choice

Amber Traffic Light  In Oxford Health sodium valproate is the preferred valproate to prescribe for bipolar disorder. Semi-sodium valproate (Depakote®) should not routinely be prescribed. Patient remains under specialist care and will be reviewed annually in clinic.

NB. MHRA Patient Safety alert (April 2018): Valproate medicines must no longer be used in women or girls of childbearing potential unless a Pregnancy Prevention Programme is in place.

In girls and women of or nearing childbearing potential, valproate should be initiated and supervised by a specialist and only when other medications have not been tolerated or have been found to be ineffective.

Black Traffic Light In pregnacy: contraindicated in pregnancy for bipolar disorder and must only be considered for epilepsy if there is no suitable alternative treatment.

APCO May 2018. 

All organisations providing NHS-funded care where valproate is prescribed or dispensed should undertake systematic identification of girls and women who are taking valproate and ensure the MHRA resources are used to support them to make informed choices.

 
Valproic Acid (Depakote®)
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Amber Traffic Light  Depakote® should not routinely be prescribed. In Oxford Health sodium valproate is the preferred valproate to prescribe for bipolar disorder.

NB. MHRA Patient Safety alert (April 2018): Valproate medicines must no longer be used in women or girls of childbearing potential unless a Pregnancy Prevention Programme is in place.

In girls and women of or nearing childbearing potential, valproate should be initiated and supervised by a specialist and only when other medications have not been tolerated or have been found to be ineffective.

Black Traffic Light In pregnacy: contraindicated in pregnancy for bipolar disorder and must only be considered for epilepsy if there is no suitable alternative treatment.

APCO May 2018. 

All organisations providing NHS-funded care where valproate is prescribed or dispensed should undertake systematic identification of girls and women who are taking valproate and ensure the MHRA resources are used to support them to make informed choices.

 
Link  MHRA Toolkit on the risks of valproate medicines in female patients
Link  MHRA: Valproate and developmental disorders: new alert asking for patient review
   
04.02.03  Lithium to top
Lithium Carbonate (Priadel®)
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First Choice
Amber Shared Care Protocol

Priadel tablets are the preferred tablet brand for use in Oxford Health.

In line with Shared Care Protocol for:

    • The acute treatment of mania
    • Prophylaxis in bipolar disorder
    • To augment antidepressants in treatment refractory recurrent depression
    • The control of aggressive behaviour or intentional self-harm



APCO May 2014.

 
Lithium Carbonate (Camcolit ® 400mg/ Essential Pharma 250mg)
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Amber Shared Care Protocol

NOTE - PRIADEL TABLETS are the PREFERRED brand.

In line with Shared Care Protocol for:

    • The acute treatment of mania
    • Prophylaxis in bipolar disorder
    • To augment antidepressants in treatment refractory recurrent depression
    • The control of aggressive behaviour or intentional self-harm



APCO May 2014.

PLEASE NOTE THAT CAMCOLIT 250mg TABLETS HAVE BEEN REBRANDED TO 'Lithium carbonate Essential Pharma 250mg'. The 400mg tablets remain as 'Camcolit' brand.

 
   
Lithium Carbonate (Essential Pharma 250mg)
(Formerely Camcolit®)
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Amber Shared Care Protocol

In line with Shared Care Protocol for:

    • The acute treatment of mania
    • Prophylaxis in bipolar disorder
    • To augment antidepressants in treatment refractory recurrent depression
    • The control of aggressive behaviour or intentional self-harm



APCO May 2014.

 
   
Lithium Citrate oral solution (Li-Liquid®)
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Amber Shared Care Protocol

Li-Liquid (lithium citrate 509mg/5mL [lithium 5.4mmol/5mL) is the preferred brand of liquid lithium in Oxford Health.

In line with Shared Care Protocol for:

    • The acute treatment of mania
    • Prophylaxis in bipolar disorder
    • To augment antidepressants in treatment refractory recurrent depression
    • The control of aggressive behaviour or intentional self-harm



APCO May 2014.

NB Lithium citrate 509mg is equivalent to lithium carbonate 200mg.

 
   
04.03  Antidepressant drugs
04.03.01  Tricyclic and related antidepressant drugs
04.03.01  Tricyclic antidepressants
Lofepramine
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Formulary
Green

Lofepramine is safer in overdose and less cardiotoxic than older tricyclic antidepressants.

 
   
Amitriptyline
(Antidepressant)
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Formulary
Green

Consider SSRIs for treatment of depression. See Prescribing Guidelines for the Management of Moderate to Severe Depression.

Tricyclic antidepressants have similar efficacy to SSRIs but are more likely to be discontinued because of side-effects; toxicity in overdosage is also a problem.

 
   
Clomipramine
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Amber Continuation

Suitable for continuation in primary care following specialist initiation.

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
   
Clomipramine Hydrochloride (Anafranil® SR)
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Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

Standard release clomipramine is preferred to modified release clomipramine. In most patients the long half-life of clomipramine from the immediate release preparation is sufficient to allow once daily dosing (usually given at night).

 
   
Imipramine
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Amber Continuation

Suitable for continuation in primary care following specialist initiation. 

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
   
Nortriptyline
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Formulary
Green

The price of nortriptyline has increased greatly, where possible consider an alternative tricyclic antidepressant.

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
   
Trimipramine
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Formulary
Amber Continuation

*** VERY HIGH COST TRICYCLIC - USE ALTERNATIVE WHERE POSSIBLE ***

Do not initiate trimipramine in new patients. People already prescribed trimipramine should have their prescription reviewed and if it is possible to use an alternative, a switch should be carried out. See deprescribing protocol (APCO March 2020). 

NHS England include trimipramine in their list of medicines which should not routinely be prescribed in primary care.

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
Link  NHS England - Items which should not be routinely prescribed in primary care 2017
   
04.03.01  Related antidepressants
Trazodone Hydrochloride
(Tablets/Capsules)
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Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation.

 
   
04.03.02  Monoamine-oxidase inhibitors to top
Phenelzine
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First Choice
Amber Continuation

First line MAOI in Oxford Health. Suitable for prescribing in primary care following specialist recommendation.

The sole UK manufacturer of phenelzine has been out of stock since mid-2019 and now have no date for a return of supply.  Phenelzine 15mg capsules, an unlicensed specials product, is now available in the UK. See OH medicines shortage bulletin here for more information.

Also see Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
Isocarboxazid
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Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation.

 
   
Tranylcypromine
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Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation.

 
   
04.03.02  Reverible MAOIs
Moclobemide
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Formulary
Amber Continuation

Suitable for continuation in primary care following initiation by Consultant Psychiatrist only.

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
   
04.03.03  Selective serotonin re-uptake inhibitors
Sertraline
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First Choice
Green

First choice antidepressant for the treatment of depression and Generalised Anxiety Disorder (GAD).



APCO September 2017.

 
Citalopram
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First Choice
Green

First choice antidepressant for the treatment of depression.

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

Alternative SSRI for Generalised Anxiety Disorder when sertraline has been ineffective (second line). See Primary Care Generalised Anxiety Disorder Guideline for Adults and Older Adults.

 
Fluoxetine
(Capsules)
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Second Choice

Green Traffic Light  Second choice for depression if no response or not tolerating first choice anti-depressants. Long half life. Higher risk of interactions due to CYP2D6 inhibition. See Prescribing Guidelines for the Management of Moderate to Severe Depression.

Amber Traffic Light  Suitable for prescribing in primary care following specialist recommendation for hypersexuality (unlicensedunlicensed).

Doses of 20mg or greater should be prescribed as capsules.

APCO January 2016.

 
Link  NICE evidence summary: Fluoxetine for hypersexuality
Link  MHRA: Caution on use in pregnancy
   
Escitalopram
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Second Choice
Green

Alternative SSRI for Generalised Anxiety Disorder when sertraline has been ineffective (second line). See Primary Care Generalised Anxiety Disorder Guideline for Adults and Older Adults.

APCO September 2017.

 
Link  MHRA: Safety advice regarding maximum doses and QT prolongation
   
Paroxetine
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Second Choice
Green

Alternative SSRI for Generalised Anxiety Disorder when sertraline has been ineffective (second line). See Primary Care Generalised Anxiety Disorder Guideline for Adults and Older Adults.

Also see Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
   
Fluvoxamine Maleate
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Second Choice
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation.

Highest incidence of gastric adverse effects. Risk of drug interactions.

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
   
Fluoxetine
(Dispersible Tablets)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

Oxford Health Drugs & Therapeutics Group Decision: for patients with swallowing difficulties, or for patients starting at 10mg (eg CAHMS patients), Olena (a scored dispersible 20mg fluoxetine tablet) should be prescribed in preference to fluoxetine liquid as the community price of the liquid can be double the price of the dispersible tablet. 

Unless liquid is indicated, doses of 20mg or greater should be prescribed as capsules.

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
   
04.03.04  Other antidepressant drugs
Mirtazapine
View adult BNF View SPC online View childrens BNF
First Choice
Green

First choice antidepressant if sedation is required, or if SSRI related adverse effects are unacceptable (GI bleeding, hyponatraemia, sexual dysfunction, insomnia).

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
Flupentixol (Fluanxol®)
(Antidepressant)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Suitable for prescribing in primary care following specialist recommendation.

 
   
Venlafaxine
View adult BNF View SPC online View childrens BNF
Formulary

Green Traffic Light  For the treatment and management of depression in adults as per NICE CG90. See Prescribing Guidelines for the Management of Moderate to Severe Depression.

Monitor blood pressure. Prominent withdrawal symptoms. No evidence that it has a greater efficacy than sertraline or mirtazapine even at higher dose.

APCO January 2017.

Black Traffic Light  Not licensed for controlling hot flushes. Not recommended for prescribing. 

APCO November 2005.

 
   
Venlafaxine XL (Vensir® XL)
(Modified-release capsules)
View adult BNF View SPC online View childrens BNF
Formulary

Green Traffic Light  For Generalised Anxiety Disorder:

 

Green Traffic Light  For moderate to severe depression:



NB. Vensir® XL capsules is the most cost-effective prolonged-release formulation, see Prescribing Points March 2017.

APCO March 2017.

Black Traffic Light  Not licensed for controlling hot flushes. Not recommended for prescribing. 

APCO November 2005.

 
   
Duloxetine
View adult BNF View SPC online View childrens BNF
Formulary

Green Traffic Light  Alternative first line options when an SSRI is contraindicated for Generalised Anxiety Disorder. See Primary Care Generalised Anxiety Disorder Guideline for Adults and Older Adults.

APCO September 2017.

Amber Traffic Light  Suitable for prescribing in primary care following specialist recommendation. See Prescribing Guidelines for the Management of Moderate to Severe Depression.

APCO March 2005.

 
   
Reboxetine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation.

Consider only if serotonergic effect is intolerable. Evidence for efficacy not as robust as others.

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

 
   
Vortioxetine (Brintellix®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation as per Oxford Health Medicines Information Bulletin: Vortioxetine for depression.

Option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episode as per NICE TA367.

APCO May 2016.

 
Link  NICE TA367: Vortioxetine for treating major depressive episodes
   
Agomelatine (Valdoxan®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Specialist prescribing only.

Fourth line treatment for Generalised Anxiety Disorder. See Primary Care Generalised Anxiety Disorder Guideline for Adults and Older Adults.

APCO September 2017.

Also see Prescribing Guidelines for the Management of Moderate to Severe Depression.

APCO July 2017. 

 
   
04.04  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
Controlled Drug Methylphenidate Hydrochloride
View adult BNF View SPC online View childrens BNF
First Choice
Amber Shared Care Protocol

For Attention Deficit Hyperactivity Disorder (ADHD) in line with Shared Care Protocol.

*Please note that adult patients will be discharged to primary care once stable as per Shared Care Protocol.

Also see:

APCO January 2018.

 
Controlled Drug Methylphenidate Hydrochloride MR
View adult BNF View SPC online View childrens BNF
First Choice
Amber Shared Care Protocol

NB. Branded generics of choice include Delmosart and Xaggitin XL.

For Attention Deficit Hyperactivity Disorder (ADHD) in line with Shared Care Protocol.

*Please note that adult patients will be discharged to primary care once stable as per Shared Care Protocol.

Also see:

APCO January 2018.

 
Atomoxetine (Strattera®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Shared Care Protocol

For Attention Deficit Hyperactivity Disorder (ADHD) in line with Shared Care Protocol.

*Please note that adult patients will be discharged to primary care once stable as per Shared Care Protocol.

Also see:

APCO January 2018.

 
Link  MHRA: Atomoxetine - risk of psychotic or manic symptoms in children and adolescents
Link  MHRA: Atomoxetine (Strattera▼) - increases in blood pressure and heart rate
   
Controlled Drug Dexamfetamine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Shared Care Protocol

For Attention Deficit Hyperactivity Disorder (ADHD) in line with Shared Care Protocol.

*Please note that adult patients will be discharged to primary care once stable as per Shared Care Protocol.

Also see:

APCO January 2018.

 
   
Controlled Drug Lisdexamfetamine (Elvanse®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Shared Care Protocol

For Attention Deficit Hyperactivity Disorder (ADHD) in line with Shared Care Protocol.

*Please note that adult patients will be discharged to primary care once stable as per Shared Care Protocol.

Also see:

APCO January 2018.

 
Link  Lisdexamfetamine (Elvanse and Elvanse Adult) for ADHD - OH Medicines Information Bulletin and DTG decision
   
Guanfacine (Intuniv®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Secondary care prescribing only for attention deficit hyperactivity disorder.

APCO May 2016.

 
Link  NICE Evidence summary: Attention deficit hyperactivity disorder in children and young people
Link  OH MI bulletin: Guanfacine for ADHD - DTG decision and prescribing information
   
Modafinil (Provigil®)
View adult BNF View SPC online View childrens BNF
Formulary

Amber Traffic Light  For excessive sleepiness associated with narcolepsy with or without cataplexy.

APCO May 2014.

Red Traffic Light  For;

  • Excessive daytime sleepiness in myotopic dystrophy (APCO May 2014)
  • Excessive daytime sleepiness in people with Parkinson's disease as per NICE NG71 (APCO January 2018).
 
Link  NICE Evidence Summary: Modafinil for excessive daytime sleepiness in Parkinson’s disease
Link  NICE Evidence Summary: Modafinil for fatigue in multiple sclerosis
Link  MHRA: Modafinil - restricted use recommended
   
04.05  Drugs used in the treatment of obesity to top
04.05.01  Anti-obesity drugs acting on the gastro-intestinal tract
Orlistat
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For weight management as per NICE CG189.

APCO January 2015.

 
Link  MHRA: Interaction with HIV medicines
Link  NICE CG189: Obesity: identification, assessment and management
   
04.05.02  Centrally acting appetite suppressants
04.06  Drugs used in nausea and vertigo
04.06  Antihistamines
Cinnarizine
View adult BNF View SPC online View childrens BNF
Formulary
Green

For vestibular disorders.

Available to purchase over the counter for motion sickness. 

 
   
Cyclizine
View adult BNF View SPC online View childrens BNF
Formulary
Green

Available to purchase from pharmacies. 

 
   
Promethazine Hydrochloride (Phenergan)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Available to purchase over the counter. 

 
   
Promethazine teoclate (Avomine®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Available to purchase over the counter. 

 
   
04.06  Phenothiazines and related drugs to top
Prochlorperazine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Levomepromazine (Methotrimeprazine)
(Injection)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

Palliative care use only.

 
   
Chlorpromazine
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For nausea and vomiting of terminal illness (where other drugs have failed or are not available).

 
   
Droperidol (Xomolix®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Secondary care use only for prevention and treatment of postoperative nausea and vomiting.

 
   
04.06  Domperidone and metoclopramide
Domperidone
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Brown Traffic Light  For short term use for nausea and vomiting only as per MHRA advice.

Domperidone is now contraindicated in people:

    • With conditions where cardiac conduction is, or could be, impaired
    • With underlying cardiac diseases such as congestive heart failure
    • Receiving other medications known to prolong QT interval or potent CYP3A4 inhibitors
    • With severe hepatic impairment

APCO July 2014.

Black Traffic Light  For use with enteral feeds as per NICE ESUOM18.

APCO January 2014.

 
Link  NICE Evidence Summary: Promoting tolerance of enteral feeds in children and young people - domperidone
Link  MHRA: Apomorphine with domperidone - risks of cardiac side effects
Link  MHRA: Domperidone - risks of cardiac side effects
Link  MHRA: Domperidone no longer available without prescription
Link  UKMI Q&A: Domperidone - New restrictions in use
   
Metoclopramide
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Green Traffic Light  For palliative care.

Restricted Item  Brown Traffic Light  For all other indications. Short term use (up to 5 days) in line with MHRA advice. Not recommended for patients under 20 years of age due to risk of dystonic reactions.  

 

 
Link  MHRA: Metoclopramide - risk of neurological adverse effects and update on restricted dose information
   
04.06  5HT3 antagonists
Ondansetron
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation.

APCO May 2010.

 
Link  MHRA: Dose restrictions for ondansetron
Link  NICE Evidence Summary: Ondansetron for vomiting in children with gastroenteritis
   
04.06  Neurokinin receptor antagonist
Aprepitant (Emend®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

To prevent nausea and vomiting associated with highly emetogenic chemotherapy not responding to standard antiemetic therapy.

 
   
Fosaprepitant (Ivemend®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

IV prodrug of aprepitant. For nil-by-mouth patients to prevent nausea and vomiting associated with highly emetogenic chemotherapy not responding to standard antiemetic therapy. 

 
   
04.06  Cannabinoid
04.06  Hyoscine to top
Hyoscine Hydrobromide
(tablets/patches)
View adult BNF View SPC online View childrens BNF
Formulary
Green

First line for antipsychotic-induced hypersalivation (unlicensed indication), as per Oxford Health Medicines Information Bulletin - Management of clozapine-induced hypersalivation.

Available to purchase over the counter as Scopoderm® patches, Kwells® and Joy-Rides® for motion sickness. 

 
Link  UKMI Q&A: Hypersalivation treatment options
   
04.06  Other drugs for Ménière's disease
Betahistine Dihydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green

For treatment of vertigo, tinnitus and hearing loss associated with Ménière's disease.

 
   
04.07  Analgesics
04.07.01  Non-opioid analgesics and compound analgesic preparations
04.07.01  Compound analgesic preparations
Paracetamol
(Injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Restricted to patients requiring pain relief but who have no reliable enteral route of administration in secondary care only.

APCO January 2006.

 
Link  MHRA: Intravenous paracetamol (Perfalgan ▼) - risk of accidental overdose
   
Paracetamol (Tablets)
(Pain)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

Only prescribe if more than 32 tablets per week are required for a chronic condition, in line with Clinical Commissioning Policy 88D

See Opioid Prescribing Guidelines for Non Cancer Pain.

APCO September 2015. 

 
Link  UKMI Q&A: Breastfeeding and paracetamol
   
Naproxen
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Paracetamol and codeine (Co-codamol® 15/500)
View adult BNF View SPC online View childrens BNF
Formulary
Green

In line with Opioid Prescribing Guidelines for Non Cancer Pain.

APCO September 2015. 

 
   
Paracetamol and codeine (Co-codamol® 30/500)
View adult BNF View SPC online View childrens BNF
Formulary
Green

In line with Opioid Prescribing Guidelines for Non Cancer Pain.

APCO September 2015. 

 
   
Paracetamol and codeine (Co-codamol® 8/500)
(Tablet)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

In line with Opioid Prescribing Guidelines for Non Cancer Pain.

See Clinical Commissioning Policy 88D on prescribing of OTC products

APCO September 2015. 

 
   
04.07.02  Opioid analgesics to top
 note 

BNF: Equivalent doses of opioid analgesics:

This is only an approximate guide (doses may not correspond with those given in clinical practice); patients should be carefully monitored after any change in medication and dose titration may be required.

Analgesic Route Dose
Codeine PO 100 mg
Diamorphine IM, IV, SC 3 mg
Dihydrocodeine PO 100 mg
Hydromorphone PO 2 mg
Morphine PO 10 mg
Morphine IM, IV, SC 5 mg
Oxycodone PO 6.6 mg
Tramadol PO 100 mg
PO = by mouth; IM = intramuscular, IV = intravenous, SC = subcutaneous
Controlled Drug Buprenorphine (Bunov® 7-day patch)
(5mcg/hr, 10mcg/hr, 20mcg/hr)
View adult BNF View SPC online View childrens BNF
First Choice
Brown

First choice brand of buprenorphine patches (replacing Butec). To be used on specialist recommendation only, in line with Opioid Prescribing Guidelines for Non Cancer Pain.

Only for patients with stable persistent pain who have swallowing difficulties or cannot tolerate other options. Not to be used for any other patient group.

APCO March 2019. 

 
Controlled Drug Buprenorphine (Hapoctasin® 72-hourly patch)
(35mcg/hr, 52.5mcg/hr, 70mcg/hr)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation as per Opioid Prescribing Guidelines for Non Cancer Pain.

Only for patients with stable persistent pain who have swallowing difficulties or cannot tolerate other options. Not to be used for any other patient group.

APCO September 2015. 

 
Link  UKMI Q&A: Minimising errors with buprenorphine patches
   
Controlled Drug Buprenorphine (Transtec® 96-hourly patch)
(35mcg/hr, 52.5mcg/hr, 70mcg/hr)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation as per Opioid Prescribing Guidelines for Non Cancer Pain.

Only for patients with stable persistent pain who have swallowing difficulties or cannot tolerate other options. Not to be used for any other patient group.

APCO September 2015. 

 
Link  UKMI Q&A: Minimising errors with buprenorphine patches
   
Codeine
(Analgesia)
View adult BNF View SPC online View childrens BNF
Formulary
Green

In line with Opioid Prescribing Guidelines for Non Cancer Pain.

APCO September 2015. 

 
Link  MHRA: Children restrictions for codeine (July 2013)
Link  MHRA: Children restrictions for codeine (June 2013)
   
Controlled Drug Diamorphine
(5mg, 10mg, 30mg, 100mg)
View adult BNF View SPC online View childrens BNF
Formulary

Green Traffic Light  For acute or severe pain.

Red Traffic Light  For substance misuse.

APCO July 2011.

 
   
Controlled Drug Diamorphine
(500mg)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Secondary care use only. 

APCO July 2011.

 
   
Dihydrocodeine
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

NB: Not included in Opioid Prescribing Guidelines for Non Cancer Pain.

 
Controlled Drug Injection Only
   
Controlled Drug Fentanyl
(Nasal spray)
View adult BNF View SPC online View childrens BNF
Formulary
Red

For acute severe pain in adolescents at Helen House (End of Life). 

APCO May 2018. 

 

 
   
Controlled Drug Fentanyl (Fencino®)
(Patch)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

Restricted for patients who have stable pain and are unable to take medication orally. In line with Opioid Prescribing Guidelines for Non Cancer Pain.

NB. Fentanyl is a very strong opioid, e.g. 50mcg/hr patch = 120mg morphine daily (Fentanyl conversion ratio table is available in the guideline).

See Good Practice Guidance: Use of Transdermal Fentanyl Patches and record sheet.

APCO September 2015. 

 
Link  NICE Evidence Summary: Moderate to severe acute post-operative pain - fentanyl transdermal patch
Link  MHRA: Fentanyl - warning regarding accidental exposure
Link  MHRA: Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure, particularly in children
Link  UKMI Q&A: Switching from morphine to fentanyl patches
   
Fentanyl  (Ionsys®)
(Transdermal system)
View adult BNF View SPC online View childrens BNF
Formulary
Red

For moderate to severe acute post-operative pain.

APCO May 2008.

 
Link  NICE Evidence Summary: Moderate to severe acute post-operative pain - fentanyl transdermal patch
Link  MHRA: Fentanyl - warning regarding accidental exposure
Link  MHRA: Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure, particularly in children
Link  UKMI Q&A: Switching from morphine to fentanyl patches
   
Controlled Drug Methadone
(Analgesic)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Controlled Drug Morphine
View adult BNF View SPC online View childrens BNF
Formulary
Green

In line with Opioid Prescribing Guidelines for Non Cancer Pain.

APCO September 2015. 

 
   
Controlled Drug Morphine suppositories
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Controlled Drug Oxycodone
(Oral)
View adult BNF View SPC online View childrens BNF
Formulary
Green

NB. Modified-release tablets: Longtec® is bioequivalent to oxycontin®. Longtec® is the first line oxycodone long acting preparation for Oxfordshire (APCO November 2013).

See Opioid Prescribing Guidelines for Non Cancer Pain.

APCO September 2015. 

 
   
Controlled Drug Oxycodone 10mg/ml
(Injection)
View adult BNF View SPC online View childrens BNF
Formulary
Green
For palliative care use only. 
   
Controlled Drug Oxycodone 50mg/ml
(Injection)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

Restricted for use in a syringe driver where volume is an issue.

APCO May 2011.

 
   
Controlled Drug Pentazocine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Controlled Drug Pethidine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Controlled Drug Tramadol
View adult BNF View SPC online View childrens BNF
Formulary
Green

Use if codeine ineffective, in line with Opioid Prescribing Guidelines for Non Cancer Pain.

APCO September 2015. 

For neuropathic pain see Guideline for the Management of Neuropathic Pain in Primary Care.

APCO March 2017.

 
   
04.07.03  Neuropathic pain
Gabapentin
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Use capsules as tablets are considerably more expensive.

See Guidelines for the Management of Neuropathic Pain in Primary Care.

APCO March 2017.

 
Link  MHRA: Gabapentin - risk of severe respiratory depression
   
Lidocaine 5% plaster (Versatis®)
(Neuropathic pain )
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation in line with Guidelines for the Management of Neuropathic Pain in Primary Care.

APCO March 2017.

 
   
Morphine
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation for neuropathic pain in line with NICE CG173.

See Guidelines for the Management of Neuropathic Pain in Primary Care.

APCO March 2017.

 
   
Topiramate
(Neuropathic pain )
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation  in line with Guidelines for the Management of Neuropathic Pain in Primary Care.

APCO March 2017.

 
   
Duloxetine
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For painful diabetic neuropathy in line with Guidelines for the Management of Neuropathic Pain in Primary Care.

Discontinue if inadequate response after trial period, review treatment  at least every 3 months.

APCO March 2017.

 
   
Pregabalin
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

Only use twice daily dosing as pregabalin is a flat-priced drug (all strengths are the same price).

Restricted in line with Guidelines for the Management of Neuropathic Pain in Primary Care.

APCO March 2017.

 
   
04.07.03  Trigeminal neuralgia
Nortriptyline
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary
Green

See Guidelines for the Management of Neuropathic Pain in Primary Care.

APCO March 2017.

 
   
04.07.03  Postherpetic neuralgia
Amitriptyline
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
First Choice
Green

See Guidelines for the Management of Neuropathic Pain in Primary Care.

APCO March 2017.

 
Imipramine
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Formulary
Green

See Guidelines for the Management of Neuropathic Pain in Primary Care.

APCO March 2017.

 
   
04.07.03  Chronic facial pain
04.07.04  Antimigraine drugs to top
04.07.04.01  Treatment of the acute migraine attack
04.07.04.01  Analgesics
Aspirin dispersible tablets
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For treatment of acute migraine, see Migraine: Acute Therapy Guidelines (Adult)

Available to purchase over the counter in line with Clinical Commissioning Policy 88D.

APCO November 2016. 

 
Paracetamol
(Oral)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For treatment of acute migraine, see Migraine: Acute Therapy Guidelines (Adult)

Available to purchase over the counter in line with Clinical Commissioning Policy 88D.

APCO November 2016. 

 
Diclofenac
(Suppository)
View adult BNF View SPC online View childrens BNF
Formulary
Green

For treatment of acute migraine, see Migraine: Acute Therapy Guidelines (Adult)

APCO November 2016. 

 
   
Ibuprofen
(Oral)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For treatment of acute migraine, see Migraine: Acute Therapy Guidelines (Adult)

Available to purchase over the counter in line with Clinical Commissioning Policy 88D.

APCO November 2016. 

 
   
Naproxen
(Oral)
View adult BNF View SPC online View childrens BNF
Formulary
Green

For treatment of acute and recurrence migraine, see Migraine: Acute Therapy Guidelines (Adult)

APCO November 2016. 

 
   
04.07.04.01  5HT1 agonists
Sumatriptan
(Oral)
View adult BNF View SPC online View childrens BNF
First Choice
Green

First line triptan for treatment of acute migraine, in line with Migraine: Acute Therapy Guidelines (Adult)

NB. RADIS formulation is BLACK listed locally.

APCO November 2016. 

 
Zolmitriptan
(Oral)
View adult BNF View SPC online View childrens BNF
First Choice
Green

First line triptan for treatment of acute migraine, in line with Migraine: Acute Therapy Guidelines (Adult)

APCO November 2016. 

 
Naratriptan (Naramig®)
View adult BNF View SPC online View childrens BNF
Second Choice
Green

For treatment of acute migraine if unaccetable side effects with first-line triptans and for recurrent migraine, in line with Migraine: Acute Therapy Guidelines (Adult)

APCO November 2016. 

 
   
Almotriptan (Almogran®)
View adult BNF View SPC online View childrens BNF
Second Choice
Green

For treatment of acute migraine if unaccetable side effects with first-line triptans, in line with Migraine: Acute Therapy Guidelines (Adult)

APCO November 2016. 

 
   
Eletriptan (Relpax®)
View adult BNF View SPC online View childrens BNF
Second Choice
Green

For treatment of acute migraine if unaccetable side effects with first-line triptans and for recurrent migraine, in line with Migraine: Acute Therapy Guidelines (Adult)

APCO November 2016. 

 
   
Frovatriptan
View adult BNF View SPC online View childrens BNF
Formulary
Green

For recurrent migraine in line with Migraine: Acute Therapy Guidelines (Adult).

APCO November 2016. 

 
   
Sumatriptan (Imigran Subject® )
(Pre-filled injection)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For treatment of acute migraine if vomiting, in line with Migraine: Acute Therapy Guidelines (Adult)

APCO November 2016. 

 
   
Zolmitriptan (Zomig®)
(Nasal spray)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For treatment of acute migraine if vomiting, in line with Migraine: Acute Therapy Guidelines (Adult)

APCO November 2016. 

 
   
04.07.04.01  Ergot alkaloids
Ergotamine Tartrate (Migril®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

For use in secondary care only.

Not included in Migraine: Acute Therapy Guidelines (Adult).

 
   
04.07.04.01  Anti-emetics to top
04.07.04.01  Other drugs for migrane
04.07.04.02  Prophylaxis of migraine
Propranolol MR
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
First Choice
Green

For prophylaxis of migraine in line with Migraine: Adult Prophylactic Therapy Guidelines

APCO January 2016. 

 
Topiramate
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
First Choice
Green

For prophylaxis of migraine in line with Migraine: Adult Prophylactic Therapy Guidelines.

APCO January 2016. 

 
Amitriptyline
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
Formulary
Green

For prophylaxis of migraine in line with Migraine: Adult Prophylactic Therapy Guidelines. Unlicensed use. 

APCO January 2016.

 
   
Atenolol
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
Formulary
Green

For prophylaxis of migraine, see Migraine: Adult Prophylactic Therapy Guidelines

APCO January 2016. 

 
   
Botulinum Toxin Type A
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
Formulary
High Cost Medicine

Red Traffic Light  Secondary care use only for chronic migraine in line with Migraine: Adult Prophylactic Therapy Guidelines and Clinical Commissioning Policy 254A

APCO January 2016.

 
   
Candesartan
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
Formulary
Green

For prophylaxis of migraine, see Migraine: Adult Prophylactic Therapy Guidelines.

APCO January 2016. 

 
   
Metoprolol
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
Formulary
Green

For prohylaxis of migraine in line with Migraine: Adult Prophylactic Therapy Guidelines

APCO January 2016. 

 
   
Pizotifen
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
Formulary
Green

For prophylaxis of migraine in line with Migraine: Adult Prophylactic Therapy Guidelines

APCO January 2016. 

 
   
Sodium valproate (Epilim®)
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
Formulary

Amber Traffic Light  For prophylaxis of migraine in line with Migraine: Adult Prophylactic Therapy Guidelines. Unlicensed use. 

APCO January 2016. 

NB. MHRA Patient Safety alert (April 2018): Valproate medicines must no longer be used in women or girls of childbearing potential unless a Pregnancy Prevention Programme is in place.

In girls and women of or nearing childbearing potential, valproate should be initiated and supervised by a specialist and only when other medications have not been tolerated or have been found to be ineffective.

Black Traffic Light  In pregnacy: contraindicated in pregnancy for bipolar disorder and must only be considered for epilepsy if there is no suitable alternative treatment.

APCO May 2018. 

All organisations providing NHS-funded care where valproate is prescribed or dispensed should undertake systematic identification of girls and women who are taking valproate and ensure the MHRA resources are used to support them to make informed choices.

 
Link  MHRA Toolkit on the risks of valproate medicines in female patients
Link  MHRA: Valproate and developmental disorders: new alert asking for patient review
   
Flunarizine 5mg
(Capsule)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

For migraine prophylaxis (unlicensed and named patient only) in line with Migraine: Adult Prophylactic Therapy Guidelines.

APCO January 2016.

 
   
04.07.04.03  Cluster headache
04.08  Antiepileptics
04.08.01  Control of epilepsy to top
Brivaracetam (Briviact®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following initiation by Epileptologists only.

For pharmacoresistant partial seizures in patients who have failed treatment with at least 3 drugs and are not on levetiracetam. Brivaracetam will be adjunctive therapy with the aim of replacing one of the patient's pre-existing anti-epileptic drugs. 

APCO March 2017.

 
   
04.08.01  Partial seizures with or without secondary generalisation
04.08.01  Generalised seizures
04.08.01  Carbamazepine and Oxcarbazepine
Carbamazepine
(Epilepsy)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
Eslicarbazepine (Zebinix®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following initiation by Epileptologists only.

For adjunctive treatment in adults as a 3rd line treatment those who have failed treatment with at least 3 drugs. Eslicarbazepine will be adjunctive therapy with the aim of replacing one of the patient's pre-existing anti-epileptic drugs. 

APCO March 2017.

 
   
Oxcarbazepine (Trileptal®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following initiation by Consultant Neurologists only.

 
   
04.08.01  Ethosuximide
Ethosuximide
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
04.08.01  Gabapentin and pregabalin to top
Gabapentin
(Epilepsy)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
Link  MHRA: Gabapentin - risk of severe respiratory depression
   
Pregabalin
(Epilepsy)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
04.08.01  Lacosamide
Lacosamide  (Vimpat®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

Monitoring requirements are as per the SPC. Patient would remain under specialist.

APCO January 2020.

 
   
04.08.01  Lamotrigine
Lamotrigine (Lamictal®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
04.08.01  Levetiracetam
Levetiracetam
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
04.08.01  Perampanel
04.08.01  Phenobarbital and other barbiturates to top
Controlled Drug Phenobarbital
(Injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red

For paediatric use only in secondary care.

 
   
Controlled Drug Phenobarbital
(Oral)
View adult BNF View SPC online View childrens BNF
Formulary

Amber Traffic Light  Suitable for continuation in primary care following specialist initiation or recommendation.

Black Traffic Light  Not recommended for the treatment of addiction.

APCO July 2011.

 
   
Primidone
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
04.08.01  Phenytoin
Phenytoin (Epanutin®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
04.08.01  Retigaine
04.08.01  Rufinamide
Rufinamide (Inovelon®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

For use in Lennox-Gastaut Syndrome in children who do not respond to other treatment.

APCO September 2008.

 
   
04.08.01  Tiagabine
Tiagabine (Gabitril®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
04.08.01  Topiramate to top
Topiramate
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
04.08.01  Valproate
Sodium Valproate
(Injection)
View adult BNF View SPC online View childrens BNF
Formulary

Red Traffic Light  Secondary care use only. 

NB. MHRA Patient Safety alert (April 2018): Valproate medicines must no longer be used in women or girls of childbearing potential unless a Pregnancy Prevention Programme is in place.

In girls and women of or nearing childbearing potential, valproate should be initiated and supervised by a specialist and only when other medications have not been tolerated or have been found to be ineffective.

Black Traffic Light  In pregnacy: contraindicated in pregnancy for bipolar disorder and must only be considered for epilepsy if there is no suitable alternative treatment.

APCO May 2018.

All organisations providing NHS-funded care where valproate is prescribed or dispensed should undertake systematic identification of girls and women who are taking valproate and ensure the MHRA resources are used to support them to make informed choices.

 
Link  MHRA Communication Materials: Valproate and risk of abnormal pregnancy outcomes
Link  MHRA Toolkit on the risks of valproate medicines in female patients
Link  MHRA: Valproate and developmental disorders - new alert asking for patient review
   
Sodium Valproate
(Epilepsy)
View adult BNF View SPC online View childrens BNF
Formulary

Amber Traffic Light  Suitable for continuation in primary care following specialist initiation or recommendation. Patient remains under specialist care and will be reviewed annually in clinic.

NB. MHRA Patient Safety alert (April 2018): Valproate medicines must no longer be used in women or girls of childbearing potential unless a Pregnancy Prevention Programme is in place.

In girls and women of or nearing childbearing potential, valproate should be initiated and supervised by a specialist and only when other medications have not been tolerated or have been found to be ineffective.

Black Traffic Light  In pregnacy: contraindicated in pregnancy for bipolar disorder and must only be considered for epilepsy if there is no suitable alternative treatment.

APCO May 2018. 

All organisations providing NHS-funded care where valproate is prescribed or dispensed should undertake systematic identification of girls and women who are taking valproate and ensure the MHRA resources are used to support them to make informed choices.

 
Link  MHRA Communication Materials: Valproate and risk of abnormal pregnancy outcomes
Link  MHRA Toolkit on the risks of valproate medicines in female patients
Link  MHRA: Valproate and developmental disorders: new alert asking for patient review
   
04.08.01  Vigabatrin
Vigabatrin (Sabril®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

 
   
04.08.01  Zonisamide
Zonisamide (Zonegran®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

APCO January 2020.

 
   
04.08.01  Benzodiazepines
Clobazam
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

Do not confuse with clonazepam.

 
   
Clonazepam
(Epilepsy)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

Do not confuse with clobazam.

 
   
04.08.01  Other Drugs to top
Perampanel (Fycompa®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation or recommendation.

APCO January 2020.

 
Link  NICE CG137: The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care
   
Retigabine (Trobalt®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Trobalt will be discontinued permanently in June 2017. This is due to the very limited usage of the medicine and not for reasons of efficacy or safety. All patients must be withdrawn from Trobalt by the end of June 2017.

For epilepsy as per NICE TA232.

Suitable for continuation in primary care following specialist initiation or recommendation.

APCO September 2011.

 
Link  NICE TA232: Retigabine for the adjunctive treatment of adults with partial onset seizures in epilepsy with and without secondary generalisation
Link  MHRA: Letter - A reminder of the retigabine (Trobalt) withdrawal
   
Stiripentol (Diacomit®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Secondary care use only for myoclonic epilepsy in infancy.

APCO November 2014.

 
   
04.08.02  Drugs used in status epilepticus
Diazepam
(Injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Secondary care use only.

 
   
Diazepam Rectal Tubes
(Status epilepticus)
View adult BNF View SPC online View childrens BNF
Formulary
Green

10mg tube can be prescribed in palliative care. 

 
   
Lorazepam
(Status Epilepticus)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Secondary care use only. 

 
   
Controlled Drug Phenobarbital injection
View adult BNF View SPC online View childrens BNF
Formulary
Red

Secondary care use only. 

 
   
Phenytoin Sodium (Epanutin® Ready Mixed Parenteral)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Secondary care use only. 

 
   
Controlled Drug Midazolam Buccal (Buccolam®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Shared Care Protocol

Prescribe by brand.

For the treatment of prolonged epileptic seizures, clusters of epileptic seizures and status epilepticus in line with Shared Care Protocol.

APCO September 2011.

 
   
Controlled Drug Midazolam Buccal (Epistatus®)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Amber Shared Care Protocol

Prescribe by brand.

For the treatment of prolonged epileptic seizures, clusters of epileptic seizures and status epilepticus in line with Shared Care Protocol.

APCO September 2011.

 
   
Clonazepam 1mg/1mL
(Status Epilepticus)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

Secondary care use only. 

 
   
Paraldehyde in olive oil
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

Secondary care use only. 

 
   
04.09  Drugs used in parkinsonism and related disorders
04.09.01  Dopaminergic drugs used in Parkinsons disease
04.09.01  Dopamine receptor agonists
Apomorphine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Shared Care Protocol

For Parkinson's disease in line with Shared Care Protocol.

APCO July 2012.

 
   
Bromocriptine
(Parkinson's)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Cabergoline (Cabaser®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Pergolide
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Pramipexole
View adult BNF View SPC online View childrens BNF
Formulary

Green Traffic Light  For severe and persistent restless legs syndrome. Previously shared care, but only dopamine agonist with a SCP. No ongoing monitoring required after first three months. GPs already initiating so no need for shared care.

APCO May 2019.

Amber Traffic Light  For Parkinson's Disease as per NICE NG71.

APCO January 2018.

Black Traffic Light  For the treatment of mild and moderate idiopathic restless legs syndrome in line with Clinical Commissioning Policy 120C.

 
Link  NICE NG71: Parkinson’s disease in adults
   
Ropinirole
View adult BNF View SPC online View childrens BNF
Formulary

Amber Traffic Light  For severe and persistent restless legs syndrome. Should be initiated by specialists, and may be continued in primary care if therapy is found to be effective in line with Clinical Commissioning Policy 120C.

Amber Traffic Light  For Parkinson's Disease.

Black Traffic Light  For the treatment of mild and moderate idiopathic restless legs syndrome in line with Clinical Commissioning Policy 120C.

 
   
Rotigotine patch (Neupro®)
(Parkinson's)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

Following specialist diagnosis in line with the recommendations for the management of Parkinson disease in NICE Clinical Guideline 35 and;

  • In patients unable to tolerate ropinirole OR
  • In patients with an insufficient response to ropinerole OR
  • In patients unable to swallow oral medicines

APCO March 2011.

For restless legs syndrome;

  • In patients unable to tolerate ropinerole OR
  • In patients with an insufficient response to ropinerole OR
  • In patients unable to swallow oral medicines

APCO May 2013.

 
   
04.09.01  Levodopa to top
Co-Beneldopa (Madopar®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Must be initiated and monitored by specialists in secondary care with expertise in management of patients with Parkinson's disease. 

Suitable for continuation in primary care.

 
   
Co-Beneldopa (Madopar® CR)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Must be initiated and monitored by specialists in secondary care with expertise in management of patients with Parkinson's disease.

Suitable for continuation in primary care.

 
   
Co-Careldopa (Half Sinemet® CR)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Must be initiated and monitored by specialists in secondary care with expertise in management of patients with Parkinson's disease.

Suitable for continuation in primary care.

 
   
Co-Careldopa (Sinemet®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Must be initiated and monitored by specialists in secondary care with expertise in management of patients with Parkinson's disease.

Suitable for continuation in primary care.

 
   
Co-Careldopa (Sinemet® CR)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Must be initiated and monitored by specialists in secondary care with expertise in management of patients with Parkinson's disease.

Suitable for continuation in primary care.

 
   
04.09.01  Monoamine-oxidase-B inhibitors
Selegiline Hydrochloride
View adult BNF View SPC online View childrens BNF
First Choice
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
Rasagiline
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

Second line for patients that cannot tolerate selegiline in Parkinson’s disease.

APCO November 2013.

 
   
04.09.01  Catachol-O-methyltransferase inhibitors
Entacapone (Comtess®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Must be initiated and monitored by specialists in secondary care with expertise in management of patients with Parkinson's disease.

APCO September 2006.

 
   
04.09.01  Amantadine
Amantadine
(Parkinson's)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Specialist initiation for Parkinson's Disease only.

 
   
04.09.02  Antimuscarinic drugs used in parkinsonism
Orphenadrine Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Procyclidine Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Trihexyphenidyl Hydrochloride (Benzhexol hydrochloride)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
04.09.03  Drugs used in essential tremor, chorea, tics, and related disorders to top
Piracetam (Nootropil®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Riluzole (Rilutek®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Shared Care Protocol

For the treatment of the Amyotrophic Lateral Sclerosis (ALS) in line with Shared Care Protocol.

APCO September 2011.

 
Link  NICE TA20: Motor neurone disease - riluzole
   
Tetrabenazine (Xenazine® 25)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
04.09.03  Torsion dystonias and other involuntary movements
Botulinum Toxin Type A
(Spasticity)
View adult BNF View SPC online View childrens BNF
Formulary

Red Traffic Light  For spasticity in line with Clinical Commissioning Policy 254A.

Black Traffic Light  For Long term Bell’s Palsy and Sialorrhoea (Severe Drooling): Not normally funded due to lack of high quality evidence of clinical and cost effectiveness, in line with Clinical Commissioning Policy 254A

 
   
04.09.04  Restless leg syndrome
04.10  Drugs used in substance dependence
04.10  Alcohol dependence
04.10.01  Alcohol dependence to top
Acamprosate (Campral EC®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
   
Disulfiram (Antabuse®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Suitable for continuation in primary care following recommendation by specialist service (Turning Point)

 
   
Nalmefene (Selincro®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

For reduction of alcohol consumption. To be prescribed only by Oxfordshire Drug and Alcohol recovery service (Turning Point).

APCO November 2014.

 
   
Naltrexone Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary

For opioid dependence see 04.10.03.

Amber Traffic Light  For continuation in primary care. To be initiated by a consultant hepatologist for the treatment of pruritus due to cholestatic liver disease only.

APCO November 2004.

 
   
04.10.02  Nicotine dependence
Nicotine replacement therapy
View adult BNF View SPC online View childrens BNF
First Choice
Brown

Restricted Item Only to be provided as part of SLA from the new smoking cessation provider

APCO March 2018.

  • Sublingual tablets
  • Orodispersible film
  • Lozenge
  • Medicated chewing-gum
  • Inhalator vapour
  • Transdermal patch
  • Spray
 
Varenicline (Champix®)
View adult BNF View SPC online View childrens BNF
First Choice
Brown

Restricted Item  Only to be provided as part of SLA from the new smoking cessation provider

APCO March 2018.

 
Bupropion Hydrochloride (Zyban®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

Only to be provided as part of SLA from the new smoking cessation provider.

APCO March 2018.

 
   
04.10.03  Opioid dependence
04.10.03  Opioid substitution therapy
Controlled Drug Buprenorphine
(Sublingual tablets)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For substance misuse refer patients to Oxfordshire Drug and Alcohol recovery service (Turning Point).

Referrals to Turning Point can be made via a dedicated form on GP Proforma Practice systems.

They also accept self-referrals from professionals, organisations, individuals and concerned family members or friends, using the referral form available on their website.

Contact details:


APCO July 2011.

 
   
Controlled Drug Methadone 1mg/ml oral solution
(Dependance)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For substance misuse refer patients to Oxfordshire Drug and Alcohol recovery service (Turning Point).

Referrals to Turning Point can be made via a dedicated form on GP Proforma Practice systems.

They also accept self-referrals from professionals, organisations, individuals and concerned family members or friends, using the referral form available on their website.

Contact details:


APCO July 2011.

 
   
04.10.03  Adjunctive therapy and symptomatic treatment
04.10.03  Opioid-receptor antagonists to top
Naltrexone Hydrochloride  (Nalorex®)
(Opioid dependence)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Brown

For substance misuse refer patients to Oxfordshire Drug and Alcohol recovery service (Turning Point).

Referrals to Turning Point can be made via a dedicated form on GP Proforma Practice systems.

They also accept self-referrals from professionals, organisations, individuals and concerned family members or friends, using the referral form available on their website.

Contact details:

 
Link  NICE TA115: Drug misuse - naltrexone
   
04.11  Drugs for dementia
Donepezil hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

For the treatment of Alzheimer's disease following recommendation by specialist or clinician with specialist expertise, except for practices signed up to Primary Care Memory Assessment Service (PCMAS) who may initiate treatment.

See Dementia Prescribing Guidelines and Clinical Commissioning Policy 134B

APCO September 2018.

 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
   
Galantamine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

For the treatment of Alzheimer's disease following recommendation by specialist or clinician with specialist expertise, except for practices signed up to Primary Care Memory Assessment Service (PCMAS) who may initiate treatment.

See Dementia Prescribing Guidelines and Clinical Commissioning Policy 134B

APCO September 2018.

 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
   
Rivastigmine
(Transdermal patch)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation

Only if patient is unable to tolerate oral therapy.

  • For Parkinson's disease dementia as per NICE NG71 (APCO January 2018).
  • For the treatment of Alzheimer's disease following recommendation by specialist or clinician with specialist expertise, except for practices signed up to Primary Care Memory Assessment Service (PCMAS) who may initiate treatment (APCO September 2018).

See Dementia Prescribing Guidelines

 
Link  NICE NG71: Parkinson’s disease in adults
   
Rivastigmine
(Oral)
View adult BNF View SPC online View childrens BNF
Formulary
Amber Continuation
  • For Parkinson's disease dementia as per NICE NG71 (APCO January 2018).
  • For the treatment of Alzheimer's disease following recommendation by specialist or clinician with specialist expertise, except for practices signed up to Primary Care Memory Assessment Service (PCMAS) who may initiate treatment. (APCO September 2018).

See Dementia Prescribing Guidelines and Clinical Commissioning Policy 134B

 
Link  NICE NG71: Parkinson’s disease in adults
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
   
Memantine hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary

In line with Dementia Prescribing Guidelines

Amber Traffic Light For new patients not currently on AChE inhibitors – Can be prescribed in primary care following recommendation by specialist or clinician with specialist expertise, as per NICE NG97.

Brown Traffic Light For patients already on AchE inhibitors – Can be started in primary care without the need for specialist advice, as per NICE NG97.

APCO September 2018.

 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
   
 ....
 Non Formulary Items
Controlled Drug  Alfentanyl Sublingual Spray 5 mg in 5mL

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Alprazolam  (Xanax®)

View adult BNF View SPC online View childrens BNF
Non Formulary

Not NHS Not NHS

 
Amitriptyline and perphenazine  (Triptafen®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Amitriptyline and perphenazine  (Triptafen-M®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Amobarbital (amylobarbitone) and secobarbital (quinalbarbitone)  (Tuinal®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Amobarbital (amylobrbitone)  (Sodium Amytal®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Analgesics  (Migraleve®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Aspirin and codeine  (Co-codaprin®)

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Non Formulary
 
Aspirin and metoclopramide  (MigraMax®)

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Non Formulary
 
Aspirin and papaveretum  (Aspav®)

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Non Formulary
 
Aspirin dispersible tablets
(Pain)

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Non Formulary

Available to purchase over the counter. 

See Clinical Commissioning Policy 88D on prescribing of OTC products. 

 
Aspirin enteric-coated
(Pain)

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Non Formulary

Please consider aspirin dispersible tablets:

  • Aspirin causes GI irritation by systemic effect.
  • There is no evidence that EC coating of low dose aspirin reduced GI side effects.
  • EC preparations are more expensive than plain tablets

 
Benperidol  (Anquil®)

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Non Formulary

Not for initiation in new patients.

 
Benzatropine

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Non Formulary
 
Botulinum Toxin Type B  (NeuroBloc®)

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Non Formulary
 
Controlled Drug  Buprenorphine
(Sublingual tablets - Pain)

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Non Formulary

See Opioid Prescribing Guidelines for Non Cancer Pain.

 
Controlled Drug  Buprenorphine  (Butrans® patch)
(5mcg/hr, 10mcg/hr, 15mcg/hr, 20mcg/hr)

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Non Formulary

Prescribe Butec® for new patients when recommended by a specialist only. Consider switching existing patients using buprenorphine 7 days patches to Butec®.

See Opioid Prescribing Guidelines for Non Cancer Pain.

 
Buprenorphine  (Espranor®)
(Oral lyophilisate)

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Non Formulary
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Not recommended for use due to safety concerns:

    • Espranor® is not interchangeable with other buprenorphine sublingual products (bioavailability is 25-30% higher).  
    • Potential for dispensing and prescribing errors. 
    • No lower strength available for dose reduction. 

Note: Espranor® is being used by the local Turning Point service but it is not expected that GPs will be requested to take over this prescribing in primary care.

APCO May 2017. 

 
Controlled Drug  Buprenorphine and Naloxone  (Suboxone®)

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Non Formulary
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Not recommended for substance misuse.

APCO July 2010.

 
Controlled Drug  Butobarbital (butobarbitone)  (Soneryl®)

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Non Formulary
 
Carbamazepine
(Postherpetic neuralgia)

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Non Formulary
 
Carbamazepine
(Trigeminal neuralgia)

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Non Formulary
 
Carbamazepine
(Dementia)

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Non Formulary
 
Chloral Betaine

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Non Formulary
 
Cinnarizine and Dimenhydrinate  (Arlevert®)

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Non Formulary
 
Clonidine  (Dixarit®)

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Non Formulary
 
Clonidine Hydrochloride  (Catapres®)

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Non Formulary
 
Clonidine Hydrochloride  (Dixarit®)

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Non Formulary
 
Co-Careldopa and Entacapone  (Stalevo®)

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Non Formulary
 
Co-Careldopa Intestinal gel  (Duodopa®)

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Non Formulary
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High Cost Medicine

Not recommended for use.

APCO July 2008.

 
Controlled Drug  Dextromoramide

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Non Formulary
 
Dihydrocodeine Tartrate  (DF 118 Forte®)

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Non Formulary

Controlled Drug Injection Only
 
Dihydrocodeine Tartrate  (DHC Continus®)

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Non Formulary

Controlled Drug Injection Only
 
Controlled Drug  Dipipanone  (Diconal®)

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Non Formulary
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For substance misuse.

APCO July 2011.

 
Dosulepin Hydrochloride

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Non Formulary
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New patients should not be initiated in general practice due to its high toxicity risk in overdose.

See Prescribing Guidelines for the Management of Moderate to Severe Depression.

APCO May 2005.

 
Doxepin

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Non Formulary

Not for use as an antidepressant.

 
Ergotamine Tartrate  (Cafergot®)

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Non Formulary
 
Controlled Drug  Fentanyl
(Buccal/ Sublingual Tablets)

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Non Formulary
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Previously ‘non-formulary’. Updating in line with NHS England Items which should not routinely be prescribed in primary care guidance.

APCO September 2019.

 
Controlled Drug  Fentanyl  (Actiq®)
(Lozenges)

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Non Formulary
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For breakthrough pain. Limited information available regarding place in therapy.

APCO November 2008.

 
Controlled Drug  Fentanyl Buccal Film  (Breakyl®)

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Non Formulary
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Previously ‘non-formulary’. Updating in line with NHS England Items which should not routinely be prescribed in primary care guidance.

APCO September 2019.

 
Controlled Drug  Fentanyl sublingual tablets  (Abstral®)

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Non Formulary
Black

Previously ‘non-formulary’. Updating in line with NHS England Items which should not routinely be prescribed in primary care guidance.

APCO September 2019.

 
Fluphenazine Hydrochloride  (Moditen®)

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Non Formulary
 
Flurazepam  (Dalmane®)

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Non Formulary
 
Fosphenytoin Sodium  (Pro-Epanutin®)

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Non Formulary
 
Granisetron

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Non Formulary
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Not recommended for prescribing.

APCO May 2010.

 
Controlled Drug  Hydromorphone  (Palladone®)

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Non Formulary
 
Controlled Drug  Hydromorphone Hydrochloride  (Palladone® SR)

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Non Formulary
 
Isometheptene Mucate  (Midrid®)

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Non Formulary
 
Controlled Drug  Ketamine oral solution

Non Formulary
 
Lamotrigine

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Non Formulary
 
Levodopa + carbidopa ER  (Numient®)

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Non Formulary
 
Liraglutide  (Saxenda®)

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Non Formulary
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Not recommended for use due to concerns around cost and safety. To be reviewed when further NICE guidance specific for liraglutide in obesity becomes available. 

APCO May 2017. 

 
Lisuride

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Non Formulary
 
Lithium Carbonate  (Liskonum®)

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Non Formulary
 
Lithium Citrate 520mg/5ml liquid  (Priadel®)

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Non Formulary
 
Lofexidine  (BritLofex®)

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Non Formulary
 
Loprazolam

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Non Formulary
 
Melatonin
(3mg tablets)

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Non Formulary
Black

Circadin remains formulary option.

APCO September 2019.

 
Melatonin 1mg and 5mg prolonged release tablets  (Slenyto® )

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Non Formulary
Black

Non formulary until further review in January as part of SCP review. licensed for a very specific paediatric group but wouldn’t cover all the indications in the current SCP.

APCO September 2019.

 
Melatonin 1mg/ml
(Oral Solution)

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Non Formulary
Black

Not licensed or recommended for use in children (contains Propylene glycol and ethanol at levels that would be not safe). Circadin remains formulary option.

APCO September 2019.

 
Controlled Drug  Meprobamate

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Non Formulary

Meprobamate: licence to be cancelled (MHRA April 2016).

  • Prescribers should review the treatment of any patient who is currently receiving a meprobamate-containing medicine with a view to switching them to an alternative treatment.
  • Prescribers should not start any new patients on medicines that contain meprobamate.
  • Do not abruptly withdraw this medicine - risk of serious and sometimes fatal side effects if patients stop treatment abruptly after using it for a long time.

 
Meptazinol  (Meptid®)

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Non Formulary
 
Controlled Drug  Methadone 5mg tablets  (Physeptone®)

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Non Formulary
Black

Not recommended for substance misuse.

APCO July 2011.

 
Controlled Drug  Methadone Hydrochloride oral solution concentrate  (Methadose®)
(10 mg/ml and 20 mg/ml)

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Non Formulary
Black

Not recommended for substance misuse.

APCO July 2011.

 
Controlled Drug  Methadone injection ampoules

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Non Formulary
Black

Not recommended for substance misuse.

APCO July 2011.

 
Methoxyflurane  (Penthrox®)

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Non Formulary
 
Methysergide  (Deseril®)

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Non Formulary
 
Metoclopramide  (Maxolon® SR)

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Non Formulary
 
Mianserin

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Non Formulary
 
Controlled Drug  Morphine and cyclizine  (Cyclimorph®)

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Non Formulary
 
Nabilone

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Non Formulary
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For the management of multiple sclerosis and chronic pain in line with Clinical Commissioning Policy 133B.

 
Naltrexone-bupropion  (Mysimba®)

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Non Formulary
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For managing overweight and obesity as per NICE TA494.

APCO January 2018.

Link  NICE TA494: Naltrexone–bupropion for managing overweight and obesity
 
Nefopam

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Non Formulary
 
Nefopam  (Acupan®)

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Non Formulary
 
Netupitant and Palonosetron  (Akynzeo®)

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Non Formulary
 
Nicotine  (e-Voke®)
(E-cigarette)

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Non Formulary
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Not prescribable. No plans for Oxfordshire County Council to use these with their smoking cessation service. 

APCO July 2017.

 
Opicapone  (Ongentys®)

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Non Formulary
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For Parkinson’s disease. Not on OUH formulary.

APCO March 2019.

 
Oxazepam

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Non Formulary
 
Controlled Drug  Oxycodone and Naloxone  (Targinact®)

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Non Formulary
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Not recommended for:

  • Pain management (APCO July 2009).
  • Restless legs syndrome (APCO March 2016).

 
Paliperidone  (Invega®)
(Oral)

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Non Formulary
Black

Paliperidone tablets are non-formulary. Risperidone is the drug of choice in line with Treatment of psychosis and schizophrenia algorithm.

NB. Paliperidone is the active metabolite of risperidone. Not considered to offer clinical advantages over other atypicals.

APCO September 2007.

 
Palonosetron  (Aloxi®)

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Non Formulary
 
Controlled Drug  Papaveretum

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Non Formulary
 
Controlled Drug  Papaveretum and Hyoscine
(Injection)

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Non Formulary
 
Paracetamol and codeine  (Co-codamol® 8/500)
(Capsule)

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Non Formulary

Tablets are more cost-effective.

 
Paracetamol and dextropropoxyphene  (Co-proxamol®)

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