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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.03.04  Expand sub section  Other antidepressant drugs
Mirtazapine
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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)
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Formulary
Green

Suitable for prescribing in primary care following specialist recommendation.

 
   
Venlafaxine
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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)
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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
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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
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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®)
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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®)
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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. 

 
   
 ....
 Non Formulary Items
Tryptophan

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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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