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Central Nervous System
| 1 DEMENTIA | ||
| NICE TA | ||
| NICE Guidance | Dementia: assessment, management and support for people living with dementia and their carers (NG97) | |
| NICE Guidance (Applicable to RIVASTIGMINE under this section) | Parkinson’s disease: Diagnosis and management in primary and secondary care [CG35] | |
| APC policy statement | Memantine with anticholinesterase inhibitors PCN Policy StatementAPC Policy Statement: AChEi and memantine for frontotemporal dementia APC Policy statement: AChEi and memantine for cognitive impairment
| |
| APC treatment pathway: | Guidance For use of AChE Inhibitors and Memantine, based on NICE NG97 | |
| ANTICHOLINESTERASES – Centrally Acting | NOTES | |
| DONEPEZIL HYDROCHLORIDE | Tablets 5mg, 10mg | Minimum of 3 months supply following initiation by specialist (psychiatrists, neurologists or care of the elderly consultants only). APC traffic light status: BLUE (information sheet) APC has listed Donepezil as ‘Black’ for treating frontotemporal dementia and cognitive impairment caused by Multiple Sclerosis as per NG97. Donepezil is not on the formulary for these indications. |
| GALANTAMINE | Tablets 8mg, 12mg SR capsules 8mg, 16mg, 24mg | Minimum of 3 months supply following initiation by specialist (psychiatrists, neurologists or care of the elderly consultants only). APC traffic light status: BLUE (information sheet) APC has listed Galantamine as ‘Black’ for treating frontotemporal dementia and cognitive impairment caused by Multiple Sclerosis as per NG97. Galantamine is not on the formulary for these indications. |
| RIVASTIGMINE | Capsules 1.5mg, 3mg | Minimum of 3 months supply following initiation by specialist (psychiatrists, neurologists or care of the elderly consultants only). APC traffic light status: BLUE (information sheet) APC has listed Rivastigmine as ‘Black’ for treating frontotemporal dementia and cognitive impairment caused by Multiple Sclerosis as per NG97. Rivastigmine is not on the formulary for these indications. |
| DOPAMINERGIC DRUGS – NMDA Receptor Antagonists | NOTES | |
| MEMANTINE | Tablets 10mg | Initiation of monotherapy APC traffic light status: BLUE Minimum of 1 months supply following monotherapy initiation by specialist (psychiatrists, neurologists or care of the elderly consultants only). Addition to AchEI with worsening cognitive functions or other markers of deterioration APC traffic light status: GREEN APC has listed Memantine as ‘Black’ for treating frontotemporal dementia and cognitive impairment caused by Multiple Sclerosis as per NG97. Memantine is not on the formulary for these indications. |
| BNF CODE – 4.2 EPILEPSY AND OTHER SEIZURE DISORDERS | ||
| ANTIEPILEPTICS | NOTES | |
| NICE Pathway | Epilepsy overview | |
| NICE Guidance | The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care [CG137] | |
| UKCPA – Consensus view on use of generic anti-epileptics | UKCPA-Generic-Antiepileptics | |
| MHRA – Switching between different Manufacturers’ Products for a particular drug | AntiEpileptics MHRA | |
| MHRA – Antiepileptic drugs: changing between different manufacturers’ products (Patient Information) | AntiEpileptics MHRA [Patients] | |
| BRIVARACETAM | Tablets 10mg, 25mg, 50mg, 75mg, 100mg | RESTRICTED FOR NEUROLOGY TEAM Adjunctive therapy in treatment of partial onset seizures who remain uncontrolled or are intolerant of all other adjunctive anti-epileptics. Brivaracetam can only be prescribed if levetiracetam has been shown to be ineffective or not tolerated Minimum of 1 months supply following initiation by specialist. APC traffic light status: BLUE (Information sheet) |
| CARBAMAZEPINE | Tablets 100mg, 200mg, 400mg CR Tablets (Tegretol Retard) 200mg, 400mg Liquid 100mg in 5ml
Suppositories 125mg, 250mg | APC traffic light status: BLUE (no information sheet)
Suppositories are licensed for up to 7 days use 125mg PR = 100mg oral dose Max dose PR = 1g in 4 divided doses |
| ESLICARBAZEPINE | 800mg, 200mg tablets | Refractory epilepsy patients who have tried and failed 2+ epilepsy agents APC traffic light status: AMBER Refer to Shared Care Guideline |
| ETHOSUXIMIDE | Capsules 250mg Syrup 250mg in 5ml | APC traffic light status: BLUE (no information sheet) Absence seizures (also myoclonic & atypical seizures) |
| GABAPENTIN | Capsules 100mg, 300mg, 400mg | APC traffic light status: BLUE (no information sheet) Adjunctive therapy (partial seizures); dose titration required also used for diabetic neuropathy Controlled Drug
|
| PREGABALIN | Capsules 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 300mg | APC traffic light status: BLUE (no information sheet) RESTRICTED for NEUROLOGY RESTRICTED for PAIN/DIABETES Team Controlled drug |
| LACOSAMIDE | Tablets 50mg, 100mg, 150mg, 200mg Liquid 10mg/ml (200ml bottle) | APC traffic light status: BLUE (no information sheet) |
| LAMOTRIGINE | Tablets 25mg, 50mg, 100mg, 200mg Tablets dispersible 5mg, 25mg, 100mg | APC traffic light status: BLUE (no information sheet)
|
| LEVETIRACETAM
| Tablets 250mg, 500mg, 750mg, 1g Oral solution 100mg / ml 250mg, 500mg, 1g sachets | RESTRICTED for NEUROLOGY team APC traffic light status: BLUE (no information sheet)
|
| Concentrate for IV infusion 100mg / ml | ||
| PERAMPANEL | Tablets 2mg, 4mg, 8mg, 10mg, 12mg | RESTRICTED for NEUROLOGY team initiation
Prescribing for minimum of 3 months following initiation by specialist. APC traffic light status: AMBER Link to Shared Care Guidance documents |
| PHENYTOIN Sodium | Capsules 25mg, 50mg, 100mg, 300mg | Phenytoin sodium is NOT EQUIVALENT to phenytoin base. When switching between products, 100mg of phenytoin sodium is approximately equivalent to 92mg of phenytoin base. APC traffic light status: BLUE (no information sheet) |
| Injection 250mg in 5ml | ||
| PHENYTOIN Base | Suspension 30mg in 5ml | Phenytoin sodium is NOT EQUIVALENT to phenytoin base. When switching between products, 100mg of phenytoin sodium is approximately equivalent to 92mg of phenytoin base. APC traffic light status: BLUE (no information sheet) |
| RUFINAMIDE | Tablets 100mg, 200mg, 400mg | RESTRICTED to paediatrics APC traffic light status: AMBER shared care document not currently available |
| SODIUM VALPROATE | Crushable Tablets 100mg EC Tablets 200mg, 500mg CR Tablets (Epilim Chrono) 200mg, 300mg, 500mg Liquid 200mg in 5ml
| For the treatment of women of childbearing potential with epilepsy OR bipolar disorder . APC traffic light status: AMBER Link to Shared Care Guideline Documents MHRA guidance: valproate use by women and girls Shared Care Agreement Communication Form APC Policy Statement: Sodium valproate (child bearing potential)ACP has classified valproate as ‘Black’ to manage agitation or aggression in people living with dementia (unless for another condition). Valproate is not on the formualary for this indication. |
| SODIUM VALPROATE | Crushable Tablets 100mg EC Tablets 200mg, 500mg CR Tablets (Epilim Chrono) 200mg, 300mg, 500mg Liquid 200mg in 5ml | For the treatment in men and women who are NOT of childbearing potential with epilepsy OR bipolar disorder. APC traffic light status: BLUE (information sheet) MHRA guidance: valproate use by women and girls APC Policy Statement: Sodium valproate in men and women not of child bearing potential ACP has classified valproate as ‘Black’ to manage agitation or aggression in people living with dementia (unless for another condition). Valproate is not on the formualary for this indication. |
| SODIUM VALPROATE | Injection 400mg in 4ml | |
| TOPIRAMATE | Tablets 25mg, 50mg, 100mg, 200mg Capsules “sprinkle” 15mg, 25mg | Restricted to paediatrics APC traffic light status: BLUE (no information sheet) |
| VIGABATRIN | Tablets 500mg Sachets 500mg | Specialist initiation only; usually adjunctive treatment though can be used as monotherapy for infantile spasms (Wests Syndrome) |
| ZONISAMIDE | Capsules 25mg, 50mg, 100mg | RESTRICTED Consultant Neurologist APC traffic light status: BLUE (no information sheet)NICE CG37 Epilepsy Diagnosis & Management SMC Rejection ZONISAMIDE (monotherapy) SMC Approval ZONISAMIDE (adjunctive therapy) |
| ANTIEPILEPTICS – BARBITURATES | NOTES | |
| PHENOBARBITAL | Tablets 15mg, 30mg, 60mg Elixir 15mg in 5ml (SF/alcohol free) | Controlled DrugAPC traffic light status: BLUE (no information sheet) |
| PRIMIDONE | Tablets 250mg Suspension 250mg in 5ml | Controlled drug |
| HYPNOTICS, SEDATIVES & ANXIOLYTICS – BENZODIAZEPINES | NOTES | |
| CLOBAZAM | Tablets 10mg | Licensed from 3yr – adult; use as adjunctive therapy in epilepsy APC traffic light status: BLUE (no information sheet) |
| CLONAZEPAM | Tablets 500 micrograms, 2mg | Used in all forms of epilepsy, status & myoclonus APC traffic light status: BLUE (no information sheet) |
| STATUS EPILEPTICUS – Benzodiazepines | NOTES | |
| LORAZEPAM | Injection 4mg/ml | |
| MIDAZOLAM | BUCCOLAM: 10mg / 2ml Oromusocal solution – 2.5mg, 5mg, 7.5mg, 10mg pre-filled syringes
EPISTATUS: 10mg / ml Oral Solution 5ml bottle + 1ml oral syringes (not pre-filled) | Midazolam Buccal [Pan-Surrey CCG Prescribing Guidance]UKCPA Statement on Generic AEDsEpilepsy Evidence Review Document MHRA Buccal Midazolam Drug Safety Alert NPSA Alert [Buccal Midazolam] APC traffic light status: BLUE (no information sheet) |
| CLONAZEPAM | Injection 1mg in 1ml | |
| DIAZEPAM | Injection solution 10mg in 2ml, injection emulsion 10mg in 2ml Rectal solution 2.5mg, 5mg, 10mg | |
| PHENYTOIN | Injection 250mg in 5ml | Intravenous Phenytoin for Status Epilepticus in Adults |
| PHENOBARBITAL SODIUM | Injection 200mg in 1ml, 60mg/1ml | Controlled drug |
| PARALDEHYDE (WITH OLIVE OIL) | Enema | Unlicensed, Paediatrics only |
| BNF CODE – 4.3 MENTAL HEALTH DISORDERS | ||
| BNF CODE – 4.3.1 Anxiety | ||
| ANTIDEPRESSANTS – Serotonin receptor agonists | NOTES | |
| BUSPIRONE | Tablets 5mg, 10mg | RESTRICTED on PSYCHIATRIC advice only |
| HYPNOTICS, SEDATIVES & ANXIOLYTICS – Benzodiazepines | ||
| CSM Advice on Benzodiazepines | Benzodiazepines used for Insomnia – Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress | |
| Medicines Q&A: What are the equivalent doses of oral benzodiazepines? | ||
| DIAZEPAM | Tablets 2mg, 5mg Liquid 2mg/5ml, 5mg/5ml Injection 10mg/2ml (Diazemuls) | APC traffic light status: GREEN |
| LORAZEPAM | Tablets 1mg Injection 4mg in 1ml | APC traffic light status: GREEN |
| OXAZEPAM | Tablets 10mg, 15mg | |
| BNF CODE – 4.3.2 Attention deficit hyperactivity disorder | ||
| CENTRAL NERVOUS STIMULANTS | NOTES NG87: Attention deficit hyperactivity disorder: diagnosis and management | |
| ATOMOXETINE | Capsules 10mg, 18mg, 25mg, 40mg, 60mg | 2nd line for ADHD – RESTRICTED to prescribing PAEDIATRIC / PSYCHIATRIC advice APC traffic light status: AMBER Shared care documents not available as not initiated at SaSH. |
| DEXAMFETAMINE | Tablets 5mg, 10mg Liquid 5mg/5ml (unlicensed) | CONTROLLED DRUG RESTRICTED on PAEDIATRIC / PSYCHIATRIC advice only Specialising in treatment of ADHD APC traffic light status: AMBER Shared care documents not available as not initiated at SaSH. |
| METHYLPHENIDATE | Tablets IR 5mg, 10mg, Tablets SR (Delmosart, Xaggitin XL, Xenidate XL ) 18mg, 27mg, 36mg, 54mg | CONTROLLED DRUG RESTRICTED on PAEDIATRIC / PSYCHIATRIC specialist advice only Treatment of APC Policy statement: Methylphenidate modified release – Preferred brands ADHD APC traffic light status: AMBER Shared care documents not available as not initiated at SaSH. |
| BNF CODE – 4.3.3 BIPOLAR DISORDER & MANIA | ||
| Important information on Lithium: . 1. Therapeutic drug monitoring 2. Toxicity 3. Prescribe by brand name 4. NPSA Alert Lithium | 1) Plasma Monitoring Required Serum level aim for 0.4-1mmol / litre Take blood sample 12hr post dose Monitor Li+ levels WEEKLY on initiation & after dose change. Thereafter when levels are stable monitor every 3-MONTHLY 2) Toxicity includes : tremour, ataxia, dysarthria, nystagmus, renal impairment and convulsions Serum levels over 2mmol / litre require Emergency Treatment of Poisoning . Seek advice from National Poisons Centre http://www.toxbase.org/ YOU WILL NEED A USERNAME AND PASSWORD . 3) Lithium preparations vary widely in bioavailability Prescribe by Brand name 4) NPSA Lithium Alert – All patients should be provided with a Lithium card. Lithium for prophylaxis of Cluster Headaches (unlicensed) | |
| NPSA Alert Lithium | NPSA Alert Lithium | |
| Important information on Lithium: . 1. Therapeutic drug monitoring 2. Toxicity 3. Prescribe by brand name 4. NPSA Alert Lithium | 1) Plasma Monitoring Required Serum level aim for 0.4-1mmol / litre Take blood sample 12hr post dose Monitor Li+ levels WEEKLY on initiation & after dose change. Thereafter when levels are stable monitor every 3-MONTHLY 2) Toxicity includes : tremour, ataxia, dysarthria, nystagmus, renal impairment and convulsions Serum levels over 2mmol / litre require Emergency Treatment of Poisoning . Seek advice from National Poisons Centre http://www.toxbase.org/ YOU WILL NEED A USERNAME AND PASSWORD . 3) Lithium preparations vary widely in bioavailability Prescribe by Brand name 4) NPSA Lithium Alert – All patients should be provided with a Lithium card. Lithium for prophylaxis of Cluster Headaches (unlicensed) | |
| VALPROIC ACID (Depakote) | Tablets 250mg, 500mg | RESTRICTED initiation on PSYCHIATRIC advice only For women of child bearning potential APC traffic light status: AMBER APC Policy Statement: Sodium valproate (child bearing potential) Shared Care Agreement Communication FormRESTRICTED initiation on PSYCHIATRIC advice only For men, and women who are not of childbearing potential. APC Policy Statement: Sodium valproate in men and women not of child bearing potentialAPC traffic light status: BLUE (information sheet) |
| LITHIUM CARBONATE 200 mg MR Tablets (Priadel) | MR Tablets 200mg, 400mg | RESTRICTED initiation on PSYCHIATRIC advice only Priadel MR is due to be discontinued in April 2021. See alert (including actions for healthcare professionals) for further details. Further guidance relating to switching and alternative formulary brands will be made available. In the interim, do not initiate patients on Priadel MR. Contact the pharmacy department for further advice. APC traffic light status: BLUE (information sheet) |
| LITHIUM CITRATE | SF Liquid (Priadel) 520mg in 5ml | RESTRICTED initiation on PSYCHIATRIC advice only APC traffic light status: BLUE (information sheet) |
| BNF CODE – 4.3.4 DEPRESSION | ||
| NICE Guidelines | Depression in adults: The treatment and management of depression in adults [CG90] | |
| NICE Guidelines | Depression in adults with chronic physical and health problems: The treatment and management [CG91] | |
| NICE Guidelines | Depression in children and young people: Identification and management in primary, community and secondary care [CG28] | |
| MONOAMINE-OXIDASE INHIBITORS – Irreversible | NOTES Caution of risk of dietary and drug interactions. See BNF for stopping and starting criteria. | |
| PHENELZINE | Tablets 15mg | RESTRICTED initiation on PSYCHIATRIC advice only |
| TRANYLCYPROMINE | Tablets 10mg | RESTRICTED initiation on PSYCHIATRIC advice only |
| MONOAMINE-OXIDASE INHIBITORS – Reversible | NOTES Caution of risk of dietary and drug interactions. See BNF for stopping ans starting criteria. | |
| MOCLOBEMIDE | Tablets 150mg | RESTRICTED initiation on PSYCHIATRIC advice only |
| NORADRENALINE RE-UPTAKE INHIBITORS | NOTES | |
| REBOXETINE 4 mg Tablets | Tablets 4mg | RESTRICTED initiation on PSYCHIATRIC advice only |
| SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS | NOTES | |
| NICE Guidelines | Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care [CG113] | |
| MHRA/CSM Advice on SSRIs Safety in Children & Adolescents | Selective Serotonin Reuptake Inhibitors (SSRIs): Overview of regulatory status and CSM advice relating to major depressive disorder (MDD) in children and adolescents including a summary of available safety and efficacy data | |
| MHRA Guidance | SSRIs and SNRIs: Use and safety | Guidance |
| UKMI Medicines Q&A | What is the risk of gastrointestinal bleeding associated with selective serotonin reuptake inhibitors (SSRIs) | |
| UKMI Medicines Q&A | ||
| CITALOPRAM | Tablets 10mg, 20mg, 40mg Oral drops 40mg/ml | 4 drops (8mg) is equivalent in therapeutic effect to a 10mg tablet. Mix with water, orange juice or apple juice before talking APC traffic light status: GREEN |
| FLUOXETINE | Capsules 20mg Liquid 20mg/5ml | APC traffic light status: GREEN |
| FLUVOXAMINE MALEATE | Tablets 50mg | RESTRICTED initiation on PSYCHIATRIC advice only |
| PAROXETINE | Tablets 20mg, 30mg Oral suspension 10mg/5ml | APC traffic light status: GREEN |
| SERTRALINE | Tablets 50mg, 100mg | APC traffic light status: GREEN |
| SEROTONIN & NORADRENALINE RE-UPTAKE INHIBITORS | NOTES | |
| DULOXETINE | Capsules 30mg, 60mg | RESTRICTED for diabetic neuropathy pain and lower urinary tract symptoms in women NICE Neuropathic Pain Guidelines PCN Treatment of Diabetic Neuropathy Guideline APC Policy statement: Duloxetine for LUTs in menAPC traffic light status: GREEN |
| VENLAFAXINE | Tablets 37.5mg, 75mg Capsules XL 75mg, 150mg | MHRA Update on CSM Advice Pre-ECG no longer pre-requisite for all patients. BP monitoring required throughout treatment. |
| SEROTONIN UPTAKE INHIBITORS | NOTES | |
| TRAZODONE | Capsules 50mg, 100mg Suspension 50mg in 5ml | |
| TETRACYCLIC ANTIDEPRESSANTS | NOTES | |
| MIANSERIN | Tablets 10mg, 30mg | RESTRICTED initiation on PSYCHIATRIC advice only |
| MIRTAZAPINE | Tablets 15mg, 30mg Dispersible Tablets 15mg, 30mg, 45mg | RESTRICTED initiation on PSYCHIATRIC advice only APC traffic light status: GREEN |
| TRICYCLIC AND RELATED ANTIDEPRESSANT DRUGS | NOTES | |
| AMITRIPTYLINE | Tablets 10mg, 25mg, 50mg Solution 25mg in 5ml | APC traffic light status: GREEN |
| CLOMIPRAMINE | Tablets 10mg, 25mg, 50mg, SR 75mg | |
| IMIPRAMINE | Tablets 10mg, 25mg | |
| LOFEPRAMINE | Tablets 70mg SF Suspension 70mg/5ml | APC traffic light status: GREEN |
| TRICYCLIC AND RELATED ANTIDEPRESSANT DRUGS | NOTES | |
| VORTIOXETINE | Tablet 5mg, 10mg, 20mg | NICE TA 367 Not for initiation at SASH APC Policy statement: Vortioxetine for major depressive episodesAPC traffic light status: GREEN |
| BNF CODE – 4.3.5 INAPPROPRIATE SEXUAL BEHAVIOUR | ||
| ANTIPSYCHOTICS – first generation | NOTES | |
| BENPERIDOL | Tablets 250 micrograms | RESTRICTED on PSYCHIATRIC advice only |
| BNF CODE – 4.3.6 PSYCHOSES & SCHIZOPHRENIA | ||
| Advice of Royal College of Psychiatrists on doses above BNF upper limit | 1) Consider alternative approaches (new atypicals, adjuvant therapy). Bear risk factors in mind (obesity) & caution (older patients) 2) Consider potential drug interactions. Carry out ECG to check for prolonged QT interval 3) Increase dose SLOWLY and not more often than ONCE WEEKLY 4) Carry out regular BP, pulse & temperature 5) Maintain adequate fluid intake 6) Abandon high dose therapy if no improvement after 3 months | |
| Royal College of Psychiatrists – Consensus statement on high dose antipsychotic medication | Consensus Statement High Dose Antipsychotics [RCPsych] | |
| NICE Guidance on Atypical Antipsychotics www.nice.org.uk Atypical Antipsychotics & Stroke The CSM has advised that olanzapine & risperidone are associated with an increased risk of stroke in elderly patients with dementia. | Following new safety concerns and the absence of formal guidance from appropriate medical organisations, the unlicensed prescribing of antipsychotics for behavioural symptoms of dementia will be restricted to Consultant Prescribing only. Statement from Chief Executive Alzheimers Society | |
| SaSH Rapid tranquilisation Policy | ||
| ANTIPSYCHOTICS – first generation | NOTES | |
| CHLORPROMAZINE | Tablets 10mg, 25mg, 50mg, 100mg Syrup 25mg/5ml, 100mg/5ml Suppositories 100mg Injection 25mg/ml (Deep IM) | |
| FLUPENTIXOL | Tablets 500micrograms, 1mg, 3mg | |
| HALOPERIDOL | Tablets 500microgram, 1.5mg, 5mg, 10mg Liquid 5mg/5ml, 10mg in 5ml Injection 5mg in 1ml | |
| PERPHENAZINE | Tablets 2mg, 4mg | RESTRICTED on PSYCHIATRIC advice only |
| PIMOZIDE | Tablets 2mg, 4mg | RESTRICTED on PSYCHIATRIC advice only |
| PROCHLORPERAZINE | Tablets 5mg Syrup 5mg in 5ml Suppositories 5mg, 25mg Injection 12.5mg/ml | ‘Green’ for nausea & vomiting |
| SULPIRIDE | Tablets 200mg Solution 200mg in 5ml | RESTRICTED on PSYCHIATRIC advice only |
| TRIFLUOPERAZINE | Tablets 1mg, 5mg Syrup 1mg/5ml, 5mg /5ml | |
| ZUCLOPENTHIXOL DIHYDROCHLORIDE | Tablets 2mg, 10mg, 25mg Oral drops 20mg/ml | RESTRICTED on PSYCHIATRIC advice only |
| ZUCLOPENTHIXOL ACETATE | Injection 50mg in 1ml, 100mg in 2ml (Accuphase) | RESTRICTED on PSYCHIATRIC advice only |
| ANTIPSYCHOTICS – First Generation (Depot Injections) | NOTES | |
| FLUPENTIXOL DECANOATE | Injection 20mg in 1ml, 40mg in 2ml Injection 50mg in 0.5ml, 100mg in 1ml (Depixol Conc) Injection 200mg in 1ml (‘low volume’) | All antipsychotic depot injections are RESTRICTED on PSYCHIATRIC advice only |
| HALOPERIDOL DECANOATE | Injection 50mg in 1ml, 100mg in 1ml | All antipsychotic depot injections are RESTRICTED on PSYCHIATRIC advice only |
| ZUCLOPENTHIXOL DECANOATE | Injection 200mg in 1ml, 500mg in 1ml (Conc.) | All antipsychotic depot injections are RESTRICTED on PSYCHIATRIC advice only |
| ANTIPSYCHOTICS – Second Generation | NOTES | |
| AMISULPRIDE | Tablets 50mg, 100mg, 200mg, 400mg Solution 500mg in 5ml | RESTRICTED on PSYCHIATRIC advice only |
| ARIPIPRAZOLE | Tablets 5mg, 10mg, 15mg | RESTRICTED on PSYCHIATRIC advice only APC traffic light status: BLUE (information sheet) |
| Injection 9.75mg/1.3ml | Rapid tranquilisation – see policy | |
| CLOZAPINE | Tablets 25mg, 50mg, 100mg Suspension 100mg in 5ml (extemporaneous) | RESTRICTED on PSYCHIATRIC advice only. Patient, prescriber and supplying pharmacist must be registered with Patient Monitoring Service. Monitor for agranulocytosis. APC traffic light status: RED |
| OLANZAPINE | Tablets 2.5mg, 5mg, 7.5mg, 10mg, 15mg Dispersible 5mg, 10mg, 15mg | ‘Black’ status for hallucinations and delusions in Parkinson’s disease. Olanzapine is not on the formulary for this indication. Psycosis +Behavioural and Psychological Symptoms of Dementia APC traffic light status: BLUE (information sheet) |
| Injection 10mg | Unlicensed medicine (EMA license) Rapid tranquilisation – see policy | |
| QUETIAPINE | Tablets 25mg, 100mg, 150mg, 200mg, 300mg | RESTRICTED on PSYCHIATRIC advice only (Patients being treated for behavioural psychotic symptoms of dementia are exempt from this restriction) APC traffic light status: BLUE (no information sheet) |
| RISPERIDONE | Tablets 500micrograms, 1mg, 2mg, 3mg, 4mg, 6mg Liquid 1mg/ml | Psychosis APC traffic light status: BLUE (information sheet) Alzeimer’s dementia APC traffic light status: GREEN APC Policy Statement: Risperidone in Alzheimer’s dementia – August 2019 |
| ANTIPSYCHOTICS – Second Generation (Depot Injections) | NOTES | |
| RISPERIDONE (Risperdal Consta) | Injection 25mg, 37.5mg, 50mg | All antipsychotic depot injections are RESTRICTED on PSYCHIATRIC advice only |
| BNF CODE – 4.4 MOVEMENT DISORDERS | ||
| BNF CODE 4.4.1 Dystonias & Other Involuntary Movements | ||
| ANTIPSYCHOTICS – first generation | NOTES | |
| PROMAZINE | Tablets 25mg Syrup 25mg in 5ml | |
| MONOAMINE DEPLETING DRUGS | NOTES | |
| TETRABENAZINE | Tablets 25mg | RESTRICTED USE Neurology Team Only Restricted for Huntingdons, movement disorders and choreas |
| MUSCLE RELAXANTS – Peripherally Acting – Neurotoxins | NOTES | |
| BOTOX (Botulinum Toxin A) | Powder for Reconstitution 100units & 200units | RESTRICTED for NEUROLOGY team Botox for Migraine – PbREX Drug (CCG Reimbursement Pre-Authorisation Required) NICE TA Botox for Migraine NICE Guidance Headache APC Policy Statement: Botulinum in chronic migraineNICE TA605: Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea PCN statement: Botulinum for chronic migraine APC Policy statement: Botox for Overactive Bladder in Men and WomenChronic sialorrhoea, Chronic migraine and overactive bladder APC traffic light status: RED Hyperhidrosis ACT traffic light status: BLACK. Not on SaSH formualary for hyperhidrosis |
| 4.2 Parkinson’s Disease | ||
| NICE Guidance | Parkinson’s disease: Diagnosis and management in primary and secondary care [CG35] | |
| CCG Shared Care Prescribing Guideline | CCG Tolcapone Shared Care (Parkinson’s) Guideline | |
| ANTIMUSCARINICS | NOTES | |
| BENZTROPINE MESILATE | 2 mg Tablets 2mg in 2ml Injection | UNLICENSED |
| ORPHENADRINE | Tablets 50mg Oral solution 25mg in 5ml, 50mg in 5ml | Parkinsons disease APC traffic light status: BLACK |
| PROCYCLIDINE | Tablets 5mg Syrup 2.5mg in 5ml, 5mg in 5ml Injection 10mg in 2ml | Parkinsons disease APC traffic light status: BLACK |
| TRIHEXYPHENIDYL HYDROCHLORIDE | Tablets 2mg, 5mg | RESTRICTED on PSYCHIATRIC advice only Parkinsons disease APC traffic light status: BLACK |
| DOPAMINERGIC DRUGS -Catechol-O-Methytransferase Inhibitors | NOTES | |
| ENTACAPONE | Tablets 200mg | COMTESS Used in adjunct to levodopa with dopa-decarboxylase inhibitor in Parkinson’s Disease & ‘end-of-dose’ motor fluctuations. APC traffic light status: BLUE (no information sheet) |
| OPICAPONE | 50mg capsules | Adjunctive therapy in adult patients with Parkinson’s Disease and end of dose motor fluctuations. Prescribing should remain with the specialist team for at least 2 months until the doses of Opicapone APC traffic light status: BLUE (no information sheet) APC Policy Statement: Opicapone for adjunctive therapy in adult patients with Parkinson’s Disease |
DOPAMINERGIC DRUGS – Dopamine Precursors | NOTES | |
| CO-BENELDOPA (MADOPAR) | Capsules 62.5mg, 125mg, 250mg Dispersible tablets 62.5mg, 125mg Controlled release capsules 125mg | APC traffic light status: BLUE (no information sheet)
|
| CO-CARELDOPA (SINEMET) | Tablets 62.5mg, 110mg, 125mg, 275mg Controlled release tablets 125mg, 250mg | APC traffic light status: BLUE (no information sheet) |
| LEVODOPA/ENTACAPONE/CARBIDOPA | Tablets 50mg/12.5mg/200mg, 75mg/18.75mg/200mg, 100mg/25mg/200mg, 125mg/31.25mg/200mg, 150mg/37.5mg/200mg, 200mg/50mg/200mg | |
| DOPAMINERGIC DRUGS – Dopamine Receptor Agonists | NOTES | |
| APOMORPHINE | Subcutaneous injection 10mg/ml in 2ml and 5ml amps | RESTRICTED Parkinson’s disease prescribing only Apomorphine AMBER Shared Care [CCG/PCN] |
| Pen injector (APO-go PFS) 10mg/ml 3ml | APC traffic light status: AMBER | |
| BROMOCRIPTINE | Tablets 2.5mg | Society for Endocrinology position statement on the use of dopamine agonists in endocrine disorders APC traffic light status: RED |
| CABERGOLINE | Tablets 1mg, 2mg, 4mg | RESTRICTED Parkinson’s disease prescribing only |
| PERGOLIDE MESYLATE | Tablets 50micrograms, 250micrograms, 1mg | RESTRICTED Parkinson’s disease prescribing only |
| PRAMIPEXOLE Tablets | Tablets 88mcg, 180mcg, 350mcg, 700mcg | RESTRICTED Parkinson’s disease prescribing only |
| ROPINIROLE Tablets | Tablets 250mcg, 500mcg, 1mg, 2mg, 5mg | RESTRICTED Parkinson’s disease prescribing only |
| ROTIGOTINE (Neupro) | Patches 2mg/24hr, 4mg/24hr, 8mg/24hr | RESTRICTED USE Parkinson’s Prescribing Team Only . Parkinson’s disease APC traffic light status: BLUE (no information sheet)Restless legs APC traffic light status: GREENSMC Approval (Neupro Patches) [early Parkinson’s] SMC Approval (Neupro Patches) [advanced Parkinson’s] Parkinson’s disease: Diagnosis and management in primary and secondary care [CG35] |
| MONO-AMINE OXIDASE INHIBITORS | NOTES | |
| RASAGILINE | Tablets 1mg | RESTRICTED USE Parkinson’s Prescribing Team Only . Parkinsons disease APC traffic light status: AMBER This agent is 2nd line for patients who fail/unable to tolerate selegiline SMC Rejection RASAGILINE (monotherapy) SMC Rejection RASAGILINE (adjunctive therapy) Parkinson’s disease: Diagnosis and management in primary and secondary care [CG35] |
| SELEGILINE | Tablets 5mg Oral liquid 10mg in 5ml | Parkinson’s disease: Diagnosis and management in primary and secondary care [CG35] . NOTE: Used in conjunction with levodopa to reduce ‘end-of-dose deterioration’ Monotherapy in early disease may delay need for levodopa therapy for a few months Start low dose 2.5mg daily in elderly to prevent confusion |
| AMANTADINE | Capsules 100mg Syrup 50mg in 5ml | Parkinson’s disease: Diagnosis and management in primary and secondary care [CG35] |
| 5 NAUSEA & LABYRINTH DISORDERS | ||
| ANTIEMETICS & ANTINAUSEANTS – Antihistamines | NOTES | |
| CYCLIZINE | Tablets 50mg Injection 50mg/ml Suppositories 50mg (unlicensed) | |
| ANTIEMETICS & ANTINAUSEANTS – Cannabinoids | ||
| NABILONE | Capsules 1mg | Chemotherapy induced nausea & vomiting in adult patients APC traffic light status: RED APC Policy Statement: Nabilone for chemo induced nausea and vomiting |
| PHENOTHIAZINES | NOTES | |
| CHLORPROMAZINE | Refer to Sec 4.2.1 | |
| PROCHLORPERAZINE | Refer to Sec 4.2.1 | |
| TRIFLUOPERAZINE | Refer to Sec 4.2.1 | |
| ANTIEMETICS & ANTINAUSEANTS – Dopamine Receptor Antagonists | NOTES | |
| DOMPERIDONE | Tablets 10mg Suspension 5mg in 5ml Suppositories 30mg | MHRA – Domperidone and risk of cardiac side-effects Nausea + vomiting (excluding pregnancy) APC traffic light status: GREEN Lactation stimulation, GORD, dyspepsia, gastroparesis, nausea + vomiting in pregnancy APC traffic light status: RED APC Policy Statement – Domperidone for GORD in adults APC Policy Statement – Domperidone for dyspepsia in adults APC Policy Statement – Domperidone for gastroparesis in adults APC Policy statement – Domperidone for nausea and vomiting in adults & adolescentsAPC Policy statement – Domperidone for nausea and vomiting in children |
| METOCLOPRAMIDE | Tablets 10mg Solution 5mg in 5ml Injection 10mg in 2ml | MHRA Safety Alert Nausea + vomiting APC traffic light status: GREEN |
| ANTIEMETICS & ANTINAUSEANTS – Neurokinin Receptor Antagonists | NOTES | |
| APREPITANT | Capsules 80mg, 125mg | RESTRICTED for CHEMOTHERAPY patientsCancer Network CINV Guidelines APC traffic light status: RED |
| ANTIEMETICS & ANTINAUSEANTS – 5HT3 Receptor Antagonists | NOTES | |
| GRANISETRON | Tablets 1mg Injection 1mg in 1ml, 3mg in 3ml | RESTRICTED for CHEMOTHERAPY patients |
| ONDANSETRON | Tablets 4mg, 8mg Oral Solution 4mg in 5ml Injection 4mg in 2ml | |
| ANTIEMETICS & ANTINAUSEANTS – Anihistamines (Sedating) | NOTES | |
| CINNARIZINE | Tablets 15mg | |
| ANTIEMETICS & ANTINAUSEANTS – Antimuscarinics | NOTES | |
| HYOSCINE HYDROBROMIDE | Tablets 300micrograms Patches 1.5mg (1mg/72 hrs) Injection 400micrograms, 600 micrograms | |
| ANTIEMETICS & ANTINAUSEANTS – Antipsychotics (first generation) | NOTES | |
| LEVOMEPROMAZINE | Tablets 25mg Injection 25mg/ml | RESTRICTED use only palliative care & oncology only (Cancer Network) |
| 5.1 Menierer’s Disease | ||
| BETAHISTINE | Tablets 8mg, 16mg | |
| 6 PAIN | ||
| ANALGESICS | ||
| NHS Surrey Chronic Pain Management Guideline | NHS Surrey Chronic Pain Management [non-malignant] | |
| NPSA alerts | NOTE: Between 2002 and 2012 patient safety alerts were issued by the National Patient Safety Agency (NPSA) – the NPSA website was archived in 2012. Please use any material with caution. NPSA Alerts were only updated to reflect changes in current safety knowledge or clinical care until the point their ‘action complete’ date was reached. Some of these ‘action complete’ dates for NSPA Alerts, Safety Notices and Rapid Response Reports are now over fifteen years in the past, and no NPSA publications have been updated since the closure of the NPSA in 2012. | |
| NON-OPIOID ANALGESICS | NOTES | |
| PARACETAMOL | Tablets 500mg, Dispersible Tablets 500mg SF Suspension 120mg in 5ml, 250mg in 5ml Suppositories 60mg, 125mg, 240mg, 500mg Injection 10mg/ml | NPSA Alert – Detecting harm following paracetamol overdose NPSA Alert – Overdose of intravenous paracetamol in infants and childrenRisk of accidental overdose with IV paracetamol
|
| CENTRALLY ACTING ANALGESICS | NOTES | |
| NEFOPAM | Tablets 30mg | |
| NON-STEROIDAL ANTI-INFLAMMATORY DRUGS | NOTES | |
| ASPIRIN | Tablets EC 300mg, Dispersible 300mg Suppositories 300mg | |
| OPIOID ANALGESICS | NOTES | |
| NPSA ALERT | NOTE: Between 2002 and 2012 patient safety alerts were issued by the National Patient Safety Agency (NPSA) – the NPSA website was archived in 2012. Please use any material with caution. NPSA Alerts were only updated to reflect changes in current safety knowledge or clinical care until the point their ‘action complete’ date was reached. Some of these ‘action complete’ dates for NSPA Alerts, Safety Notices and Rapid Response Reports are now over fifteen years in the past, and no NPSA publications have been updated since the closure of the NPSA in 2012. | NPSA Opioid Rapid Response AlertNOTE: This guidance applies to the following opioids: buprenorphine, diamorphine, dipipanone, fentanyl, hydromorphone, meptazinol, methadone, morphine, oxycodone, papaveretum, pethidine |
| Medicines Q&A – what are the equivalent doses of oral morphine to other oral opioids when used as analgesia in adult palliative care? | ||
| Medicines Q&A – How should conversion from oral morphine to fentanyl patches be carried out? |
| |
| BUPRENORPHINE | S/L Tablets (Temgesic) 200 micrograms & 400 micrograms 7 days Patches (Butrans) 5micrograms/hr, 10micrograms/hr, 15micrograms/hr, 20micrograms/hr 96 hour Patches (Transtec) 35 micrograms/hour, 52.5micrograms/hour, 70 micrograms/hour | CONTROLLED DRUG NPSA Opioid Rapid Response Alert |
| CODEINE PHOSPHATE | Tablets 15mg, 30mg Syrup 25mg in 5ml, Linctus 15mg in 5ml (licensed for cough) Injection 60mg in 1ml (CD) | |
| )DIAMORPHINE | Intra Nasal Diamorphine AyendiAE | Paediatric Prescribing ONLY
|
| Injection 5mg, 10mg, 15mg Injection 30mg, 100mg, 500mg | CONTROLLED DRUG RESTRICTED SUPPLIES Discuss with pharmacy CONTROLLED DRUG RESTRICTED SUPPLIES NPSA Alert on High Dose Morphine/Diamorphine NPSA Safer Practice Notice 12 (Actions for the NHS) New regulations on high dose storage/acquisition & supply Discuss with pharmacy NPSA Opioid Rapid Response AlertNPSA – Safer Practice Notice – High dose ampoules of Diamorphine and Morphine | |
| DIHYDROCODEINE | Tablets 30mg Solution 10mg in 5ml Injection 50mg in 1ml (CD) | NPSA Opioid Rapid Response Alert |
| FENTANYL | Sublingual tablets (Abstral) 100mcg, 200mcg, 300mcg, 400mcg, 600mcg, 800mcg Buccal lozenges (Actiq) 200mcg, 400mcg, 600mcg, 800mcg | Controlled Drug RESTRICTED : Palliative Care & Pain Management |
| Patches (72 hour) 25mcg/hr, 50mcg/hr, 75mcg/hr, 100mcg/hrm | CQC Guidance Controlled Drug CAUTION : Fever or External Heat CAUTION : Risk of Fatal Respiratory Depression RESTRICTED: for prescribing in palliative care | |
| MORPHINE SULPHATE | IR Tablets 10mg, 20mg, 50mg (Sevredol) | Dose every 4-6 hours / prn |
| Tablets 5mg Injection 50mg in 5ml Solution 10mg in 5ml, 100mg in 5ml (Oramorph Conc.) MR Tablets 5mg (MST) MR Capsules (Zomorph) 10mg, 30mg, 60mg, 100mg, 200mg MR Sachet 30mg (MST Continus) Injection 10mg in 1ml, 15mg, 20mg 30mg in 1ml, 60mg in 2ml, 50mg in 50ml, 100mg in 100ml (PCA bags)
TOPICAL MORPHINE 10mg with INTRASITE GEL 10ml | Controlled Drug For SUSTAINED RELEASE ORAL MORPHINE Dose every 12 hours / twice daily PARENTAL MORPHINE RESTRICTED SUPPLIES New regulations on high dose storage/acquisition & supply – Discuss with pharmacy NPSA – Safer Practice Notice – High dose ampoules of Diamorphine and Morphine Medicines Commissioning Group Statement: Morphine sulfate MR (July 2019)
RSCH Treatment of Radiotherapy Side-Effects RSCH Management of Acute Perineal Skin Toxicity During Radiotherapy | |
| OXYCODONE | Capsules (Shortec) 5mg, 10mg, 20mg Oral solution 5mg in 5ml , 10mg in 1ml MR Tablets (Oxylan) 10mg, 20mg, 40mg, 80mg Injection 10mg in 1ml, 20mg in 2ml | Oxycodone is a second-line option for patients with intolerable side-effects or poor response to morphine Short Acting Oral Oxycodone CQC – Safer use of Controlled Drugs – Preventing harm from Oral Oxycodone preparations Dose every 4-6 hours / prn Sustained Release Oral Oxycodone CQC – Safer use of Controlled Drugs – Preventing harm from Oral Oxycodone preparations Dose every 12 hours / twice daily |
| PETHIDINE | Tablets 50mg Injection 50mg in 1ml, 100mg in 2ml, 50mg in 5ml, 100mg in 5ml | Controlled Drug |
| TAPENTADOL | Tablets SR 50mg, 100mg, 200mg | RESTRICTED to patients with severe persistent pain who have not responded to / not tolerated morphine OR oxycodone APC traffic light status: BLUE (no information sheet) |
| Tablets 50mg | ||
| TRAMADOL | Capsules 50mg Dispsersible Tablets 50mg SR Capsules 50mg, 100mg, 200mg Injection 100mg in 2ml | CONTROLLED DRUG |
| COMPOUND ANALGESIC PREPARATIONS | NOTES | |
| CO-CODAMOL (PARACETAMOL + CODEINE) | Tablets 8/500, 30/500, migaleve Effervescent Tablets 8/500, 30/500 | |
| CO-DYDRAMOL | Tablets 10/500 | |
| MIGRALEVE (PARACETAMOL + CODEINE + BUCLIZINE) | Pink Tablets, Duo Tablets | |
| 6.1 Headache | ||
| ANTIHISTAMINES – Sedating | ||
| PIZOTIFEN | Tablets 500micograms | |
| MIGRAINE – Triptans | NOTES | |
| SUMATRIPTAN SUCCINATE | Tablets 50mg, 100mg Nasal spray 10mg in 0.1ml Injection 6mg in 0.5ml | APC traffic light status: GREEN |
| MIGRAINE – Prophylaxis | NOTES | |
| PROPRANOLOL | Tablets 10mg, 40mg, 80mg | |
| FREMANEZUMAB | 22mg/1.5ml pre-filled syringe | TA631: Fremanezumab for preventing migraine |
| 6.2 Neuropathic Pain | ||
| ANALGESICS – Plant Alkaloids | NOTES | |
| CAPSAICIN | 0.025% cream | APC traffic light status: GREEN |
| 7 SLEEP DISORDERS | ||
| 7.1 Insomnia | ||
| Important information | There is no convincing evidence that these agents are useful in the elderly. The use of hypnotics in children is not usually justified | |
| HYPNOTICS & ANXIOLYTICS – benzodiazepines | NOTES | |
| LOPRAZOLAM | Tablets 1mg | Anxiety APC traffic light status: GREEN |
| LORMETAZEPAM | Tablets 500micrograms, 1mg | |
| NITRAZEPAM | Tablets 5mg Oral Liquid 2mg/5ml | Long acting; avoid in elderly |
| TEMAZEPAM | Tablets 10mg Elixir 10mg in 5ml | Controlled Drug |
| HYPNOTICS, SEDATIVES & ANXIOLYTICS – Non-Benzodiazepine | NOTES | |
| CHLORAL HYDRATE | Elixir 500mg in 5ml | |
| CLOMETHIAZOLE | Capsules 192mg Syrup 250mg in 5ml | |
| MELATONIN | Tablets MR 2mg | Second line for adult patients with primary insomnia when conventional ‘z’ drugs are ineffective or contraindicated. Licensed for 13 week use only. APC 2019 Melatonin (Circadin) tablets – Insomnia in adultsAPC has classified melatonin as ‘Black’ for insomnia in people with Alzheimer’s disease (unless indicated for another condition). It is not on the formulary for this indication. See NICE guidance (NG97) – Dementia: assessment, management and support for people living with dementia and their carers. APC Policy Statement: Melatonin NICE do not offer |
| Tablets MR 2mg Liquid 1mg/ml | Paediatrics (off-label) Kidmel Brand used for paediatrics (alcohol, sugar and colorant free) Surrey PCN [Circadin] Paed Sleep Disorders APC Policy statement: Melatonin in children & adolescents for sleep disordersAPC traffic light status: AMBER APC has classified the Colonis 1mg/ml liquid brand as ‘Black’ for sleep disorders in children. Colonis brand is not on the formulary. APC 2019 Melatonin 1mg per ml oral solution (Colonis) – Children off label use | |
| Slenyto MR Tablets 1mg, 5mg tablets. | RESTRICTED Only for treatment of insomnia in children and adolescent ages 2-18years with autism spectrum disorder (ASD) and / or Smith-Magenis Syndrome, where sleep hygiene measures have been insufficient. NOTE: Slenyto APC traffic light status: BLACK APC 2019 Melatonin (Slenyto) – Insomnia in children and adolescents | |
| ZOLPIDEM | Tablets 5mg, 10mg | Though zolpidem is a non-benzodiazepines hypnotics, it acts at the benzodiazepine receptor. It is not licensed for long term use. Dependence has been reported in a small number of patients. |
| ZOPICLONE | Tablets 3.75mg, 7.5mg | Though zopiclone is a non-benzodiazepines hypnotics, it acts at the benzodiazepine receptor. It is not licensed for long term use. Dependence has been reported in a small number of patients. |
| 7.2 Narcolepsy | ||
| CNS STIMULANTS – Centrally Acting Sympathomimetics | NOTES | |
| MODAFINIL | Tablets 100mg | Narcolepsy APC traffic light status: AMBER |
| 8 SUBSTANCE DEPENDENCE | ||
| 8.1 Alcohol Dependence | ||
| CHLORDIAZEPOXIDE | Capsules 5mg, 10mg | Used 1st line for alcohol withdrawal |
| ACAMPROSATE | Tablets 333mg | RESTRICTED USE Drugs & Alcohol Team Only Restricted for treatment of Alcohol Dependence |
| DISULFIRAM | Tablets 200mg | RESTRICTED USE Drugs & Alcohol Team Only Restricted for treatment of Alcohol Dependence |
| 8.2 Nicotine Dependence | ||
| NICOTINE | NICORETTE Microtab 2mg Up to 20 cigarettes daily More than 20 cigarettes daily NICORETTE Chewing Gum 2mg & 4mg Up to 20 cigarettes daily More than 20 cigarettes daily NICOTINELL TTS Patches Additional Prescribing Information Step 1 = ’30’ Patch (21mg/24hr) Step 2 = ’20’ Patch (14mg/24hr) Step 3 = ’10’ Patch (7mg/24hr) | PATIENTS EXPERIENCING NICOTINE WITHDRAWAL |
| 8.3 Opioid Dependence | ||
| OPIOIDS | NOTES | |
| METHADONE | Oral solution 1mg in 1ml Concentrated oral solution 10mg in 1ml | CONTROLLED DRUG |
| BUPRENORPHINE | Sublingual tablets 400micrograms, 2mg, 8mg | SUBUTEX CONTROLLED DRUG |
| LOFEXIDINE | Tablets 200 micrograms | |
| NALTREXONE | Tablets 50mg | |
| DRUGS USED IN ESSENTIAL TREMOR,CHOREA,TICS ETC. | NOTES | |
| RILUZOLE | Tablets 50mg | RESTRICTED USE Neurology Team Only . Restricted for amyotrophic lateral sclerosis and motor neurone diseaseRiluzole MS Shared Care SASH PbRE Intention to Treat NICE TAG Riluzole [TA20] APC traffic light status: AMBER |
| BOTULINUM TYPE A TOXIN (Botox) | Vial 100 units | RESTRICTED USE See APC/D&T Guidance for Approved Use |
| ADDITIONAL TOPICS | ||
| CLADRIBINE | 10mg tablet | Prescribing should be by an NHS specialist only, in line with NICE and/or local pathways. Funded by NHSE. Suitable for shared care between specialist centre and secondary care. multiple sclerosis TA616 Cladribine for treating relapsing–remitting multiple sclerosis |
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