| Formulary Chapter 4: Central nervous system - Full Chapter
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 OCCG Guidelines: Primary Care Generalised Anxiety Disorder Guideline for Adults and Older Adults |
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| 04.02.01 |
Antipsychotic Drugs |
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| 04.02.01 |
Second-Generation Antipsychotic Drugs |
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Risperidone
(Oral)
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First Choice
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 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.
Suitable for continuation in primary care following specialist initiation and stabilisation, as an augmentation or combination treatment for depression, as per prescribing algorithm and full prescribing guidelines.
APCO November 2020.
  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.
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 MHRA: Risk of intraoperative floppy iris syndrome in people undergoing cataract surgery
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Aripiprazole
(Orodispersible)
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Formulary
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Only if recommended by secondary care in patients with swallowing difficulty or where supervised consumption is needed. APCO November 2006.
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Amisulpride
(Oral)
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Formulary
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Suitable for continuation in primary care following specialist initiation in line with Treatment of psychosis and schizophrenia algorithm and monitoring guidelines.
Suitable for primary care prescribing following specialist initiation, as an augmentation or combination treatment for depression, as per prescribing algorithm and full prescribing guidelines.
APCO November 2020.
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.
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Aripiprazole
(Tablet)
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Formulary
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 For moderate to severe manic episodes in adolescents with bipolar disorder.
APCO September 2013.
Suitable for continuation in primary care following specialist initiation for schizophrenia in people aged 15 to 17 years.
APCO May 2011.
Suitable for continuation in primary care following specialist recommendation in line with Treatment of psychosis and schizophrenia algorithm.
APCO September 2004.
Suitable for continuation in primary care following specialist initiation and stabilisation, as an augmentation or combination treatment for depression, as per prescribing algorithm and full prescribing guidelines.
APCO November 2020.
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.
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NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
NICE TA292: Bipolar disorder (children) - aripiprazole
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Aripiprazole
(Short acting IM injection)
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Formulary
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For secondary care psychiatrist prescribing only, in line with Treatment of psychosis and schizophrenia algorithm.
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Cariprazine
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Formulary
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Secondary care use only.
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Loxapine (Adasuve®)
(Inhalation powder)
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Formulary
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For prescribing by Mental Health Specialists only. APCO September 2017.
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Lurasidone
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Formulary
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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.
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Olanzapine
(Oral)
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Formulary
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Suitable for continuation in primary care following specialist recommendation in line with Treatment of psychosis and schizophrenia algorithm.
Suitable for continuation in primary care following specialist initiation and stabilisation, as an augmentation or combination treatment for depression, as per prescribing algorithm and full prescribing guidelines.
APCO November 2020.
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.
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Olanzapine Oral lyophilisate (Zyprexa® Velotabs)
(Oral)
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Restricted
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ORODISPERSIBLE TABLETS are restricted for palliative or end of life care patients with swallowing difficulties and for patients with feeding tubes only.
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Quetiapine (Standard-release)
(Oral)
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Formulary
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 Suitable for continuation in primary care following specialist recommendation in line with Treatment of psychosis and schizophrenia algorithm.
Suitable for continuation in primary care following specialist initiation and stabilisation, as an augmentation or combination treatment for depression, as per prescribing algorithm and full prescribing guidelines.
APCO November 2020.
 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.
 For generalised anxiety disorder due to limited evidence suggesting no greater efficacy than antidepressants.
APCO July 2013.
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NICE Evidence summary: Quetiapine for generalised anxiety disorder
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Quetiapine XL (Modified-release)
(Oral)
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Formulary
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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.
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NICE Evidence summary: Quetiapine for generalised anxiety disorder
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Sertindole (Serdolect®)
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Formulary
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Named patient drug. Specialist prescribing only.
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Olanzapine
(Short-acting injection)
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 Unlicensed
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Specialist prescribing only in line with Treatment of psychosis and schizophrenia algorithm.
Olanzapine IM is not licensed in the UK. Unlicensed preparations are available.
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| Non Formulary Items |
Ziprasidone (Zeldox®)
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Non Formulary
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Unlicensed in the UK. |
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Zotepine (Zoleptil®)
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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Red: Medicines which should only be prescribed in secondary care by a specialist. |
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Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred. |
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Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO). |
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Green: Medicines which are suitable for initiation and ongoing prescribing within primary care. |
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Brown: Medicines which should only be prescribed in restricted circumstances. |
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Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety. |
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not used |
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