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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.02.03  Expand sub section  Drugs used for mania and hypomania
Lamotrigine
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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Patients stabilised on lamotrigine for bipolar disorder may require dose adjustments if other drugs are added to or withdrawn from their treatment regimens.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  Expand sub section  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  Expand sub section  Antipsychotic drugs
04.02.03  Expand sub section  Carbamazepine
Carbamazepine
(Mania)
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Amber Continuation

Suitable for continuation in primary care following specialist recommendation.

 
   
04.02.03  Expand sub section  Valproic acid to top
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. 

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  Expand sub section  Lithium
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.

 
   
 ....
 Non Formulary Items
Lithium Carbonate  (Liskonum®)

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

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

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.   

Amber Shared Care Protocol

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).   

Green

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

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