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 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:

Opioid Resource Pack

Gabapentinoid Reduction Leaflet

 Details...
04.01  Hypnotics and anxiolytics
04.01.01  Hypnotics
Melatonin
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Licensed 2mg modified-release tablets (Circadin) first line

Restricted to CAMHS, LD, community paediatricians and occasional use in Parkinson's Disease.

Paediatrics including CAMHS: "off label" use – see shared care

 
Link  Melatonin Prescribing Guidance
Link  Melatonin Shared Care for children with severe sleep disorders
Link  NICE Sleep Disorders in ADHD ESUOM2
   
04.01.01  Benzodiazepines
Controlled Drug Temazepam
(hypnotic)
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2

Use zopiclone 1st line

 
   
Nitrazepam
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Very limited place in therapy – specialist initiation only  

Not suitable for older people due to long duration of action and subsequent high risk of falls

 
   
04.01.01  Zaleplon, Zolpidem and Zopiclone
Zopiclone
View adult BNF View SPC online
First Choice
Green 1
 
Zaleplon (Sonata®)
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Formulary
Green

In line with NICE

 
Link  NICE TA77
   
Zolpidem
View adult BNF View SPC online View childrens BNF
Formulary
Green

In line with NICE

 
Link  NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
   
04.01.01  Chloral and derivatives to top
Chloral Hydrate 500mg in 5mL
(Cloral mixture, BP 2000 )
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

UNLICENSED! Hospital use only. 

For sedation for painless procedures in paediatrics 

 

 

 
   
04.01.01  Clomethiazole (Chlormethiazole)
04.01.01  Antihistamines
Promethazine Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green

Sedating, mainly mental health use.

 

 
   
04.01.01  Alcohol
04.01.01  Sodium oxybate
04.01.02  Anxiolytics to top
04.01.02  Benzodiazepines
Diazepam
View adult BNF View SPC online View childrens BNF
First Choice
Green 1

First choice for short term use in anxiety disorders.

DO NOT prescribe 10mg tablets - subject to misuse

 
Oxazepam
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2

Short acting, useful for patients with liver failure

 
   
Chlordiazepoxide
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

For alcohol detoxification

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

Usually specialist initiated / recommended

NB 1mg lorazepam is equivalent to 10mg Diazepam

Tablets may be given sublingually

 
   
04.01.02  Buspirone
04.01.02  Beta blockers
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
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Haloperidol
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Levomepromazine (Nozinan®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

Palliative Care use only [Previously methotrimeprazine (Nozinan®)]

 
   
Prochlorperazine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Promazine Hydrochloride (Promazine®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
   
Sulpiride
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
   
Zuclopenthixol (Clopixol®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Prescribe generically

 
   
Zuclopenthixol Acetate (Clopixol Acuphase®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

NOT suitable for primary care prescribing!

Short acting preparation for management of acute psychosis in secondary care (Clopixol Acuphase®) 

 
   
04.02.01  First-Generation Antipsychotic Drugs
04.02.01  Second-Generation Antipsychotic Drugs
Amisulpride
(tablet)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
   
Aripiprazole
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
Link  NICE TA292: Bipolar disorder (children) - aripiprazole
   
Clozapine
View adult BNF View SPC online View childrens BNF
Formulary
Red

 

Not suitable for primary care prescribing: complex monitoring required

 
   
Lurasidone (Latuda®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Occasional use, named patients only NICE ESNM48

 
   
Olanzapine
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Formulary
Amber
 
   
Quetiapine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Standard release tablets are first line.

Reserve MR tablets for acute phase initiation.

Prescribe MR tablets as Sondate XL (or Biquelle XL) brand in primary care if clinically necessary.

 
   
Quetiapine MR (Sondate® XL)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

HCCG brand of choice for acute phase initiation

 
   
Risperidone
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
   
04.02.02  Antipsychotic depot injections to top
Aripiprazole (Abilify Maintena®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
Flupentixol Decanoate
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Haloperidol
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
   
Olanzapine Embonate (ZypAdhera®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Named patient use only

 
   
Paliperidone
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Xeplion® monthly, Trevicta® 3 monthly

 
   
Risperidone (Risperdal Consta®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
Zuclopenthixol Decanoate
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
   
04.02.03  Drugs used for mania and hypomania
Lamotrigine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Off label use for mood stabilisation supported by NICE

MHRA Cat 2

 
   
04.02.03  Benzodiazepines
04.02.03  Antipsychotic drugs
04.02.03  Carbamazepine
04.02.03  Valproic acid to top
Valproic Acid (Episenta)
View adult BNF View SPC online View childrens BNF
First Choice
Green

1st line for new patients and at dose change.

See MHRA warnings on valproate in women of childbearing age

 
Sodium valproate
(Mania)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Episenta brand 1st line for new patients and at dose change.

See MHRA warnings on valproate in women of childbearing age

 

 
   
04.02.03  Lithium
Lithium Carbonate
View adult BNF View SPC online View childrens BNF
Formulary
Amber

See shared care and NICE CG185 See Safer Lithium Therapy recommendations.

Prescribe by brand. If no brand specified default formulary brand is Priadel®.

Patients must be given a lithium treatment pack on initiation and encouraged to keep monitoring booklet up to date.

 
   
Lithium Citrate
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Lithium citrate liquid 520mg (Priadel® liquid) equiv. to 204mg lithium carbonate

Lithium citrate liquid 509mg (Li Liquid®) equiv. to 200mg lithium carbonate.

Care required when transferring between tablet and liquid formulations due to different bioavailability 

 
   
04.03  Antidepressant drugs
 note 

NICE CG90 Depression in adults

04.03.01  Tricyclic and related antidepressant drugs
04.03.01  Tricyclic antidepressants
 note 

Do not use tricyclics to treat depression in patients over 75 years old

Amitriptyline
(antidepressant)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Clomipramine
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
   
Imipramine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Lofepramine
View adult BNF View SPC online View childrens BNF
Formulary
Green

Lower risk in overdose than other tricyclics 

 
   
04.03.01  Related antidepressants to top
Trazodone
View adult BNF View SPC online View childrens BNF
Formulary
Green

Occasional use in patients with dementia

 
   
04.03.02  Monoamine-oxidase inhibitors
Phenelzine
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Prescribe generically

See BNF for dietary advice for patients taking MAOIs

 
   
04.03.02  Reverible MAOIs
Moclobemide
View adult BNF View SPC online View childrens BNF
Formulary
Green

See BNF for specific dietary advice for moclobemide

 
   
04.03.03  Selective serotonin re-uptake inhibitors
Citalopram
View adult BNF View SPC online View childrens BNF
First Choice
Green 1
 
Fluoxetine
View adult BNF View SPC online View childrens BNF
First Choice
Green 1

Long half life may be beneficial in patients with adherence issues

 
Sertraline
View adult BNF View SPC online View childrens BNF
First Choice
Green 1

Fewer interactions and first choice in patients with cardiac disease

 
Escitalopram (Cipralex®)
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2

2nd line

 
   
Paroxetine
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Second Choice
Green 2

Withdrawal syndrome more common

 
   
Vortioxetine
View adult BNF View SPC online View childrens BNF
Third Choice
Amber

Use only after inadequate response to 2 antidepressants in current episode in line with NICE TA367

 
Link  NICE TA367 - Vortioxetine for treating major depressive episodes
   
04.03.04  Other antidepressant drugs
Mirtazapine
View adult BNF View SPC online View childrens BNF
Formulary
Green

15mg dose is more sedating than 30mg

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

Standard release preparations are BD dosing.

Modified release (MR) capsules and tablets OD dosing.

 
   
04.04  CNS stimulants and other drugs used for attention deficit hyperactivity disorder to top
Atomoxetine
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
   
Controlled Drug Dexamfetamine
View adult BNF View SPC online View childrens BNF
Formulary
Red

Not suitable for primary care prescribing.

 

 
   
Controlled Drug Lisdexamfetamine (Elvanse®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Consultant initiation only

 
   
Controlled Drug Methylphenidate
View adult BNF View SPC online View childrens BNF
Formulary
Amber

 See shared care for ADHD 

 
   
Controlled Drug Methylphenidate Hydrochloride MR
View adult BNF View SPC online View childrens BNF
Formulary
Amber

Prescribe as brand: MR caps brands are not interchangeable.

Prescribe 18mg, 27mg, 36mg, 54mg as Xaggitin® XL - equivalent to Concerta® XL. 

 
   
Modafinil
View adult BNF View SPC online View childrens BNF
Formulary
Amber

For neurology initiation in narcolepsy

Occasional use in daytime sleepiness in Parkinsons Disease  (NICE NG71)

 
   
04.04  Cocaine
04.05  Drugs used in the treatment of obesity
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
Amber

Limited place in therapy – dietitian initiation only. NICE pathway

See CCG Low Priority Medicines guidance

 
   
04.05.02  Centrally acting appetite suppressants
04.06  Drugs used in nausea and vertigo to top
04.06  Vomiting during pregnancy
04.06  Postoperative nausea and vomiting
04.06  Motion sickness
04.06  Other vestibular disorders
04.06  Cytotoxic chemotherapy to top
04.06  Palliative care
04.06  Migraine
04.06  Antihistamines
Cyclizine
View adult BNF View SPC online View childrens BNF
First Choice
Green 1
 
Cinnarizine
View adult BNF View SPC online View childrens BNF
Formulary
Green

Motion sickness, vertigo

 
   
04.06  Phenothiazines and related drugs
Prochlorperazine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
04.06  Domperidone and metoclopramide to top
Domperidone
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2
 
Link  MHRA Safe Prescribing Guidelines
   
Metoclopramide
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2
 
Link  MHRA Safe Prescribing Guidelines
   
04.06  5HT3 antagonists
Ondansetron
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2

Ondansetron first line post-operative anti-emetic in hospital.

Injection and suppositories restricted to secondary care use.

 
Link  WVT Post-operative Nausea and Vomiting Guidelines
   
04.06  Neurokinin receptor antagonist
04.06  Cannabinoid
Nabilone
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
 
   
04.06  Hyoscine
Hyoscine Hydrobromide
(tablets/patches)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Used for hypersalivation

OTC for travel sickness indication

 
   
04.06  Other drugs for Ménière's disease to top
Betahistine Dihydrochloride
View adult BNF View SPC online View childrens BNF
First Choice
Green 1

For Ménière’s disease

 
04.07  Analgesics
04.07.01  Non-opioid analgesics and compound analgesic preparations
04.07.01  Compound analgesic preparations
Aspirin
View adult BNF View SPC online View childrens BNF
Formulary
Green

Prescribe as dispersible tablets

 
   
Nefopam
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

Specialist advice only

Occasional use for patients intolerant or allergic to opioids

 
   
Paracetamol
View adult BNF View SPC online View childrens BNF
Formulary
OTC

Tablets and suspension for self-purchase in primary care unless for treatment of long term condition as per NHSE guidance

 

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

Prescribe as Zapain in Primary Care

 
   
Paracetamol and codeine (Co-codamol® 8/500)
View adult BNF View SPC online View childrens BNF
Formulary
OTC

For self-purchase in primary care

For long term use consider prescribing "when required" codeine separately

 
   
Paracetamol and dihydrocodeine (Co-dydramol®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Dihydrocodeine 10mg and Paracetamol 500mg

NB other strengths of co-dydramol now available

 
   
04.07.02  Opioid analgesics
Codeine
(analgesia)
View adult BNF View SPC online View childrens BNF
First Choice
Green 1

Codeine-containing medicines should only be used in children over 12 years old to treat acute (short lived) moderate pain, and only if it cannot be relieved by other painkillers such as paracetamol or ibuprofen. Contra-indicated in any patient under 18 years old who undergoes the removal of tonsils or adenoids for the treatment of sleep apnoea. Not recommended in 12-18 yr olds with breathing problems.

MHRA advice April 2015 and July 2013 on use in children and adolescents.

Known to be misused and subject to drug seeking behaviour.

 
Controlled Drug Morphine (Zomorph®)
View adult BNF View SPC online View childrens BNF
First Choice
Green 1

First choice opioid for oral and sub-cut/syringe driver use.

Immediate release (IR) for titration and breakthrough pain

Prescribe modified release preparations by brand as good practice to ensure consistency of supply.

Zomorph® capsules may be opened and sprinkled onto food.

Prescribe 10mg in 1ml ampoules in primary care

 
Controlled Drug Morphine Salts (Oramorph®)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Immediate release (IR) for titration and breakthrough pain

 

 

 
Controlled Drug Morphine Salts (Sevredol®)
View adult BNF View SPC online View childrens BNF
First Choice
Green

Immediate release (IR) for titration and breakthrough pain

 

 
Controlled Drug Buprenorphine (Butec® patch)
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2

For patients with poor swallow who are unable to tolerate higher doses of opioids.

Prescribe as BuTec. 5mcg/hr patch approx equivalent to 12mg oral morphine. 

 
   
Dihydrocodeine
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2

Known to be misused and subject to drug seeking behaviour.

 
   
Controlled Drug Fentanyl (Matrifen)
(Patch)
View adult BNF View SPC online View childrens BNF
Third Choice
Green 3

Prescribe by brand as good practice to ensure consistency of supply.

MATRIFEN is HCCG brand of choice

 
   
Controlled Drug Tramadol
View adult BNF View SPC online View childrens BNF
Third Choice
Green 3

Use capsules (standard release) first line. If MR necessary prescribe as brand Tramulief® in primary care

NOT recommended for routine use in primary care and should NOT be considered as an alternative to codeine/or stepping up to stronger opioids.

 
Link  Nociceptive Pain
   
Controlled Drug Buprenorphine (Temgesic®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Controlled Drug Diamorphine Hydrochloride Injection
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Controlled Drug Fentanyl Nasal Spray (PecFent®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

Second line use by the Palliative Care team for incident pain only. Not for routine use for breakthrough pain with fentanyl patches. 

 
   
Controlled Drug Fentanyl sublingual tablets (Abstral®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

Second line use by the Palliative Care team for incident pain only. Not for routine use for breakthrough pain with fentanyl patches. 

 
   
Controlled Drug Pethidine
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Injection for maternity inpatient use only.

 

 
   
Controlled Drug Oxycodone modified release tablets
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

Oral preparation

Palliative care only for those unable to tolerate morphine or in patients with renal impairment.

Prescribe by brand as good practice to ensure consistency of supply.

HCCG brand of choice LYNLOR for standard release and OXYPRO for modified release preparations and are stocked by Out Of Hours pharmacies for emergency supplies.

 

 
   
Controlled Drug Tapentadol (Palexia®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

 Specialist initiation only by pain consultant

 
   
04.07.03  Neuropathic pain to top
Amitriptyline
View adult BNF View SPC online View childrens BNF
First Choice
Green 1

Off-label use . Routinely used and included in NICE (CG173) guidelines

 

 

 
Gabapentin
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2

Titrate slowly - see guidance

 
Link  HCCG Neuropathic Guidelines
   
Pregabalin
(Neuropathic pain)
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2

Titrate slowly – see guidance

Because of price structure for pregabalin, ensure dose optimisation is carried out.
Pregabalin dose spread over two daily doses proved non-inferior to three times a day dosing: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007076.pub2/pdf

 
Link  HCCG Neuropathic Guidelines
   
Duloxetine
View adult BNF View SPC online View childrens BNF
Formulary
Green 2
 
   
Controlled Drug Ketamine oral solution
Restricted Drug Restricted
Amber

Pallative Care Use Only - See Shared Care

 

 
Link  Ketamine Shared Care
   
04.07.03  Trigeminal neuralgia
04.07.03  Postherpetic neuralgia
04.07.03  Chronic facial pain
04.07.04  Antimigraine drugs
04.07.04.01  Treatment of the acute migraine attack to top
04.07.04.01  Analgesics
04.07.04.01  5HT1 agonists
Sumatriptan
View adult BNF View SPC online View childrens BNF
First Choice
Green 1

Generically prescribed tablets 1st line. Nasal spray for paediatrics only.

 
Zolmitriptan
View adult BNF View SPC online View childrens BNF
First Choice
Green 1

Generically prescribed tablets and dispersible tablets. 

 
04.07.04.01  Ergot alkaloids
04.07.04.01  Anti-emetics
04.07.04.01  Other drugs for migrane to top
04.07.04.02  Prophylaxis of migraine
Propranolol
View adult BNF View SPC online View childrens BNF
First Choice
Green 1
 
Amitriptyline
(Migraine prophylaxis)
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2

Off label use

 
   
Pizotifen
View adult BNF View SPC online View childrens BNF
Second Choice
Green 2
 
   
04.07.04.03  Cluster headache
04.08  Antiepileptics
04.08.01  Control of epilepsy
Brivaracetam (Briviact®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

Adjunctive therapy in partial-onset seizures with or without secondary generalisation, in patients from 16 years of age with severe refractory epilepsy warranting tertiary specialist input and have tried three or more AEDs. Patient has documented intolerance to levetiracetam and is using a third line agent (perampanel, zonisamide, lacosamide, eslicarbazepine) which would be replaced by brivaracetam. MHRA cat 3 (prescribe generically).

 
Link  Brivaracetam Shared Care
   
04.08.01  Partial seizures with or without secondary generalisation to top
04.08.01  Generalised seizures
04.08.01  Carbamazepine and Oxcarbazepine
Carbamazepine
(Epilepsy)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Prescribe by brand for epilepsy. Tegretol is preferred brand. MHRA cat 1.

Serum levels can be useful – narrow therapeutic index

 
Link  MHRA Advice
   
Eslicarbazepine (Zebinix®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

MHRA cat 2

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

Epilepsy in line with NICE

MHRA cat 2 prescribe by brand

 
Link  NICE Guidance
   
04.08.01  Ethosuximide
Ethosuximide
View adult BNF View SPC online View childrens BNF
Formulary
Green

MHRA cat 3 (prescribe generically)

 
   
04.08.01  Gabapentin and pregabalin
Gabapentin
(Epilepsy)
View adult BNF View SPC online View childrens BNF
Formulary
Green

MHRA cat 3 (prescribe generically)

 
   
Pregabalin
(Epilepsy)
View adult BNF View SPC online View childrens BNF
Formulary
Green

MHRA cat 3 (prescribe generically)

 
   
04.08.01  Lacosamide to top
Lacosamide  (Vimpat ® )
View adult BNF View SPC online View childrens BNF
Formulary
Green

MHRA cat 3 (prescribe generically)

 
   
04.08.01  Lamotrigine
Lamotrigine
View adult BNF View SPC online View childrens BNF
Formulary

MHRA cat 2

 
   
04.08.01  Levetiracetam
Levetiracetam
View adult BNF View SPC online View childrens BNF
Formulary
Green

MHRA cat 3 (prescribe generically)

 
   
04.08.01  Perampanel
04.08.01  Phenobarbital and other barbiturates
Controlled Drug Phenobarbital
View adult BNF View SPC online View childrens BNF
Formulary
Green

MHRA cat 1 prescribe by brand

 
   
04.08.01  Phenytoin to top
Phenytoin
(Oral)
View adult BNF View SPC online View childrens BNF
Formulary
Green

MHRA cat 1 prescribe by brand

Monitor serum levels, narrow therapeutic index

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

Anti-epileptic - tertiary centres only

 

 
   
04.08.01  Rufinamide
04.08.01  Tiagabine
04.08.01  Topiramate to top
Topiramate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Epilepsy

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

MHRA cat 2 prescribe by brand

Episenta - First line for new patients

 

 
Link  MHRA Guidance for Women of Child Bearing Potential
   
Sodium Valproate (Epilim® Intravenous)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Hospital only

 
   
04.08.01  Vigabatrin
Vigabatrin (Sabril®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

Epilepsy in line with NICE

 

 
Link  NICE Guidelines Epilepsy
   
04.08.01  Zonisamide
Zonisamide (Zonegran®)
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Formulary
Amber

Capsules

In Line With NICE CG137 (Replaces TA76 and TA79)
Treatment of refractory focal seizures if initial adjunctive treatment has failed. For specialist initiation, transfer to primary care once stable.

MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
   
04.08.01  Benzodiazepines
Clobazam
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Formulary
Green

 Tablets, oral suspension

In Line With NICE CG137 (Replaces TA76 and TA79)
Specialist recommendation(adults) or initiation(children)

MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history 

"SLS" in primary care – epilepsy only

 
   
04.08.01  Other Drugs to top
Acetazolamide
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Restricted Drug Restricted
Amber

 For ophthalmic use, see glaucoma section (11.6)

Off label use by specialist respiratory team for type 2 respiratory failure

 

 
   
Perampanel
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Restricted Drug Restricted
Amber

Epilepsy: neurologist initiation

MHRA Cat 2 prescribe by brand

 

 
Link  NICE CG137: The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care
   
04.08.02  Drugs used in status epilepticus
Diazepam (epilepsy)
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First Choice
Green 1

Rectal 1st line for status epilepticus

 
Clonazepam
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Formulary
Green

 In Line With NICE CG137 (Replaces TA76 and TA79)

For specialist recommendation (Adults) or initiation (Children)
MHRA Category 2:- The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

 
   
Lorazepam
(epilepsy)
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Restricted Drug Restricted
Red

Intravenous preparation for inpatient use only

 
   
Controlled Drug Midazolam
(Epilepsy)
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Formulary
Amber

Specialist Initiation

Prescribe as Buccolam 10mg/2ml strength available in 2.5mg, 5mg, 7.5mg and 10mg pre-filled syringes, colour coded for age appropriate dosing. 

Buccolam® and Epistatus® are not interchangeable and there is high risk of harm if patients receive the incorrect brand and strength of buccal midazolam.

DO NOT PRESCRIBE UNLICENSED PREPARATIONS

Licensed for under 18 years but used for adults off-label in line with MHRA

 
   
Paraldehyde Enema
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Formulary
Red

Secondary Care use only

 
   
Controlled Drug Phenobarbital injection
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Restricted Drug Restricted
Red

Intravenous preparation for inpatient use only

 
   
Phenytoin
(IV)
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Restricted Drug Restricted
Red

Intravenous preparation for inpatient use only

 
   
Phenytoin Sodium (Epanutin® Ready Mixed Parenteral)
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Restricted Drug Restricted
Red

Intravenous preparation for inpatient use only

 
   
04.08.03  Febrile convulsions
04.09  Drugs used in parkinsonism and related disorders
04.09.01  Dopaminergic drugs used in Parkinsons disease
04.09.01  Dopamine receptor agonists to top
Apomorphine (APO-go® or Dacepton®)
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Formulary
Amber

Sub-cut infusion or prefilled pen under direction of PD team - see shared care

Prescribe by brand as devices differ.

Dacepton® first line for new patients

 
Link  Apomorphine Shared Care
   
Bromocriptine
(Parkinsons)
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Formulary
Amber

Ergot-derived dopamine-receptor agonist no longer initiated in Parkinson’s Disease 

 
   
Cabergoline
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Formulary
Amber

No longer initiated in Parkinsons Disease

 

 
   
Pramipexole
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Formulary
Green

Dopamine agonist (non-ergot derived) 

Prescribe standard release preparation generically and MR by brand as Pipexus® prolonged release

 
   
Ropinirole
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Formulary
Amber

Specialist Initiation Only

Dopamine agonist (non-ergot derived) 

Prescribe standard release preparation generically and MR by brand as Repinex® XL or Ipinnia® XL

 
   
Rotigotine
(Parkinsons)
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Formulary
Amber

Specialist Initiation Only

Dopamine agonist (non-ergot derived).  PATCHES

Used to help control continued night-time motor symptoms despite adequate treatment with oral prolonged release dopamine agonist.

Titrate dose in steps of 2mg/24hr at weekly intervals; max dose 8mg/24hr as monotherapy up to 16mg as adjunctive therapy.

 

 
   
04.09.01  Levodopa
Co-Beneldopa (Madopar®)
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Formulary
Green

Prescribe by brand as Madopar

Caution with selecting correct product to prescribe, dispense, administer

 
   
Co-Beneldopa (Madopar®CR)
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Formulary
Green

Prescribe by brand as Madopar

Caution with selecting correct product to prescribe, dispense, administer

 
   
Co-Careldopa (Half Sinemet ®CR)
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Formulary
Green

Prescribe by brand as Sinemet

Caution with selecting correct product to prescribe, dispense, administer

 
   
Co-Careldopa (Sinemet®)
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Formulary
Green

Prescribe by brand as Sinemet

Caution with selecting correct product to prescribe, dispense, administer

 
   
Co-Careldopa (Sinemet® CR)
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Formulary
Green

Prescribe by brand as Sinemet

Caution with selecting correct product to prescribe, dispense, administer

 
   
Co-Careldopa and Entacapone
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Formulary
Green

Prescribe as brand Sastravi® to ensure continuity for patients

 
   
Levodopa
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Formulary
Green
 
   
04.09.01  Monoamine-oxidase-B inhibitors
Rasagiline
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Formulary
Green

 Monoamine-oxidase-B inhibitors 

 
   
Selegiline Hydrochloride
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Formulary
Green

Monoamine-oxidase-B inhibitors

 
   
04.09.01  Catachol-O-methyltransferase inhibitors
Entacapone (Comtess®)
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First Choice
Green 1

COMT inhibitor

 
Opicapone
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Second Choice
Green 2

 2nd line COMT inhibitor for patients unable to tolerate entacapone 

 
   
04.09.01  Amantadine
Amantadine
(Parkinson's)
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Restricted Drug Restricted
Amber

Used in dyskinetic patients

 
   
04.09.02  Antimuscarinic drugs used in parkinsonism to top
Procyclidine
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First Choice
Green 1

Short term use for patients experiencing extrapyramidal side effects to antipsychotics.

Prescribe as Kemadrin brand in Primary Care

May be stimulant and subject to misuse. Treatment over 6 months should be reviewed & gradually reduced and stopped if patients are asymptomatic

 
Trihexyphenidyl
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Second Choice
Green 2

Alternative to procyclidine

 
   
Orphenadrine
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Formulary
Amber

Historic use only. Only available as liquid preparation 

 
   
04.09.03  Drugs used in essential tremor, chorea, tics, and related disorders
Haloperidol
(essential tremor)
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Formulary
Green

Unlicensed indication

Motor tics and symptoms of Tourette syndrome & related choreas

 
   
Riluzole (Rilutek®)
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Restricted Drug Restricted
Amber
High Cost Medicine

 For Motor Neurone Disease  in line with NICE TA20

 
Link  NICE TA20: Motor neurone disease - riluzole
   
Tetrabenazine (Xenazine® 25)
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Restricted Drug Restricted
Amber

Huntington’s chorea & related disorders

 
   
04.09.03  Torsion dystonias and other involuntary movements
Botulinum A toxin (Botox®)
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Restricted Drug Restricted
Red

Restricted to use outlined in Herefordshire Treatment Policy

 
Link  Herefordshire Treatment Policy
   
Botulinum A toxin (Dysport®)
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Restricted Drug Restricted
Red

Restricted to use outlined in Herefordshire Treatment Policy

 
Link  Herefordshire Treatment Policy
   
Botulinum B toxin (NeuroBloc®)
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Restricted Drug Restricted
Red

Named patient basis

Restricted to only where Botulinum A ineffective

 
   
04.10  Drugs used in substance dependence
04.10  Alcohol dependence
04.10  Cigarette smoking to top
Nicotine (Nicorette® Invisi patches)
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Restricted Drug Restricted
Red

Not for FP10 prescribing. Refer all patients to Hereford council Healthy Lifestyle Trainer Service (HLTS) for behavioural support and access to pharmacotherapy. 01432 383567 healthylifestyle.trainerservice@nhs.net

NICE NG92

 
   
Nicotine (Nicotinell®)
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Restricted Drug Restricted
Red

Not for FP10 prescribing. Refer all patients to Hereford council Healthy Lifestyle Trainer Service (HLTS) for behavioural support and access to pharmacotherapy. 01432 383567 healthylifestyle.trainerservice@nhs.net

NICE NG92

 
   
Nicotine (NiQuitin® CQ)
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Restricted Drug Restricted
Red

Not for FP10 prescribing. Refer all patients to Hereford council Healthy Lifestyle Trainer Service (HLTS) for behavioural support and access to pharmacotherapy. 01432 383567 healthylifestyle.trainerservice@nhs.net

NICE NG92

 
   
04.10  Opioid dependence
Naltrexone Hydrochloride (Opizone®)
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Restricted Drug Restricted
Red

Prescribing to remain with specialist

 
   
04.10.01  Alcohol dependence
Acamprosate (Campral EC®)
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Formulary
Amber

 Initiated by Addaction in line with their treatment guidelines 

 
   
Disulfiram (Antabuse®)
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Formulary
Amber

Initiated by Addaction in line with their treatment guidelines

 
   
Nalmefene
(Selincro)
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Restricted Drug Restricted
Red

Only prescribed in conjunction with continuous psychosocial support in line with NICE TA235

 
   
Naltrexone
(alcohol dependence)
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Restricted Drug Restricted
Red

Specialist prescribing only

50mg tablets licensed for substance misuse, other strengths are unlicensed and not appropriate for primary care prescribing

 
   
04.10.02  Nicotine dependence
Bupropion Hydrochloride (Zyban®)
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Restricted Drug Restricted
Red

Not initiated in hospital

Not for FP10 prescribing. Refer all patients to Hereford council Healthy Lifestyle Trainer Service (HLTS) for behavioural support and access to pharmacotherapy. 01432 383567 healthylifestyle.trainerservice@nhs.net

 
   
Nicotine
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Restricted Drug Restricted
Red

Not for FP10 prescribing. Refer all patients to Hereford council Healthy Lifestyle Trainer Service (HLTS) for behavioural support and access to pharmacotherapy. 01432 383567 healthylifestyle.trainerservice@nhs.net

NICE NG92

 
   
Varenicline (Champix®)
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Restricted Drug Restricted
Red

Not initiated in hospital.

Not for FP10 prescribing. Refer all patients to Hereford council Healthy Lifestyle Trainer Service (HLTS) for behavioural support and access to pharmacotherapy. 01432 383567 healthylifestyle.trainerservice@nhs.net

NICE TA123

 
Link  NICE TA123: Varenicline
   
04.10.03  Opioid dependence
04.10.03  Opioid substitution therapy to top
Controlled Drug Buprenorphine (Subutex®)
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Restricted Drug Restricted
Amber

Initiated & monitored by Addaction  

 
   
Controlled Drug Buprenorphine and Naloxone (Suboxone®)
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Restricted Drug Restricted
Red

Short term use for high risk patients in line with Addaction guidance

 
   
Controlled Drug Methadone
(Dependance)
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Restricted Drug Restricted
Red Amber

Oral Solution 1mg/ml sugar free. Initiated & monitored by Addaction.

Tablets prescribed by Addaction only when patients travelling by air as more likely to be diverted and misused 

 

 
   
04.10.03  Adjunctive therapy and symptomatic treatment
Lofexidine (BritLofex®)
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Restricted Drug Restricted
Red

Specialist prescribing only

 
   
04.10.03  Opioid-receptor antagonists
Naltrexone (Nalorex®)
(opioid dependence)
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Restricted Drug Restricted
Red

Prescribing to remain with specialist

 
Link  NICE TA115: Drug misuse - naltrexone
   
04.11  Drugs for dementia
Donepezil
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Formulary
Amber

Orodispersible tablets reserved for use in swallowing difficulties.

See Dementia shared care for more information. May be recommended for initiation by community dementa nurses.

 
   
Galantamine
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Formulary
Amber

Tablets and liquid. Liquid reserved for use in swallowing difficulties 

Prescribe MR as Gatalin XL.

Dementia - see shared care. May be recommended for initiation by community dementa nurses.

 
   
Memantine
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Formulary
Amber

Prescribe generically

Tablets and liquid. Liquid reserved for use in swallowing difficulties 

Dementia - see shared care. May be recommended for initiation by community dementa nurses.

 

 
   
Rivastigmine
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Formulary
Amber

Tablets, liquid and patch (Use Alzest® brand for patches). Liquid & patch formulations reserved for use in swallowing difficulties.

Dementia - see shared care. May be recommended for initiation by community dementa nurses.

 
   
 ....
 Non Formulary Items
Agomelatine  (Valdoxan®)

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Non Formulary

Withdrawn from local formulary on grounds of lack of clinical effectiveness; not included in NICE depression guidelines

 
Controlled Drug  Alfentanyl Sublingual Spray 5 mg in 5mL

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Non Formulary
 
Almotriptan  (Almogran®)

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Non Formulary
 
Alprazolam

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Non Formulary
 
Amantadine  (Lysovir®)
(Influenza)

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Non Formulary
 
Controlled Drug  Amobarbital (amylobarbitone) and secobarbital (quinalbarbitone)  (Tuinal®)

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Non Formulary
 
Controlled Drug  Amobarbital (amylobrbitone)  (Sodium Amytal®)

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

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Non Formulary
 
Asenapine
(Sycrest)

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Non Formulary
 
Aspirin  (Nu-Seals® Aspirin)

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Non Formulary

No evidence of benefit over dispersible aspirin

 

 
Aspirin + Codeine  (Co-codaprin®)

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Non Formulary
 
Aspirin + Metoclopramide  (MigraMax®)

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Non Formulary
 
Aspirin + Papaveretum  (Aspav®)

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Non Formulary
 
Buspirone Hydrochloride

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Non Formulary
 
Buspirone Hydrochloride  (Buspar®)

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Non Formulary
 
Controlled Drug  Butobarbital (butobarbitone)  (Soneryl®)

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Non Formulary
 
Cinnarizine and Dimenhydrinate  (Arlevert®)

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Non Formulary
 
Clomethiazole  (Heminevrin®)

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Non Formulary
 
Clonazepam
(Mania)

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Non Formulary
 
Co-proxamol

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Non Formulary
 
Diazepam
(febrile convulsions)

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Non Formulary
 
Controlled Drug  Dihydrocodeine Tartrate  (DHC Continus®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Dipipanone  (Diconal®)

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Non Formulary
 
Dosulepin

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Non Formulary

 Removed from formulary, Low Value Medicine, safer alternatives

 
Doxepin

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Non Formulary

Removed from formulary, Low Value Medicine, safer alternatives

 
Duloxetine  (Ventreve®)

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Non Formulary
 
Eletriptan  (Relpax®)

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Non Formulary
 
Ergotamine Tartrate  (Cafergot®)

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Non Formulary
 
Ergotamine Tartrate  (Migril®)

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Non Formulary
 
Controlled Drug  Fentanyl
(Actiq lozenges)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Fentanyl  (Effentora® buccal tablets)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Fentanyl  (Instanyl® nasal spray)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Fluoxetine TABLETS
(unlicensed special)

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Non Formulary
Red

Use licensed oral solution for doses smaller than 20mg

 
Flurazepam  (Dalmane®)

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Non Formulary
 
Fluvoxamine Maleate  (Fluvoxamine®)

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Non Formulary
 
Fosphenytoin Sodium  (Pro-Epanutin®)

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

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Non Formulary
 
Gabapentin  (Neurontin®)

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Non Formulary

Prescribe generically. MHRA Cat 3

 
Guanfacine  (Intuniv®)

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Non Formulary
 
Controlled Drug  Hydromorphone  (Palladone®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Isocarboxazid

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Non Formulary

No longer initiated due to higher cost

 
Isometheptene Mucate  (Midrid®)

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Non Formulary
 
Levodopa + carbidopa ER  (Numient®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Liraglutide  (Saxenda®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Loprazolam

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Melatonin
(Cluster headache)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Melatonin
(Primary insomnia)

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Non Formulary
 
Melatonin  (Adult Critical Care)

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Non Formulary
 
Controlled Drug  Meprobamate

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Meptazinol  (Meptid®)

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Non Formulary
 
Controlled Drug  Methadone Hydrochloride  (Methadose®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Methoxyflurane  (Penthrox®)

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Non Formulary
 
Controlled Drug  Morphine and cyclizine  (Cyclimorph®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Morphine Salts  (MST Continus®)

View adult BNF View SPC online View childrens BNF
Non Formulary

Except 5mg tablets

 
Controlled Drug  Morphine suppositories

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Naltrexone/ bupropion  (Mysimba®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Black

 NICE "Do not do"

Link  Nice TA494: Naltrexone–bupropion for managing overweight and obesity
 
Naratriptan  (Naramig®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nicotine  (e-Voke®)
(E-cigarette)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paliperidone

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Non Formulary

Lack of evidence of superiority to risperidone for oral preparation

 
Controlled Drug  Papaveretum

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Non Formulary
 
Controlled Drug  Papaveretum
(Papaveretum with hyoscine injection)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol and methionine  (Pardote®)

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Non Formulary
 
Paracetamol and metoclopramide  (Paramax®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pergolide

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Non Formulary

No longer used in Parkinsons Disease

 

 
Pimozide

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Non Formulary
 
Piracetam  (Nootropil®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pitolisant  (Wakix®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Primidone

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Non Formulary
 
Prochlorperazine  (Buccastem® (Bucal preparation))

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Rizatriptan  (Maxalt®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Safinamide

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Secobarbital (quinalbarbitone)  (Seconal Sodium® )

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sibutramine Hydrochloride  (Reductil®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Sodium Oxybate  (Xyrem®)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine
 
Sumatriptan  (Imigran® Radis)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Targinact (Oxycodone/Naloxone)  (Targinact®)
(Pain)

View adult BNF View SPC online View childrens BNF
Non Formulary
Not Recomended / Black

 See Herefordshire LPT Low Value Medicine 

 
Controlled Drug  Targinact (Oxycodone/Naloxone)  (Targinact®)
(Restless legs)

View adult BNF View SPC online View childrens BNF
Non Formulary
Not Recomended / Black

See Herefordshire LPT Low Value Medicine

 
Tiagabine  (Gabitril®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tolcapone  (Tasmar®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tolfenamic Acid  (Clotam®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Tramadol Hydrochloride and paracetamol  (Tramacet®)

View adult BNF View SPC online View childrens BNF
Non Formulary

See Herefordshire LPT Low Value Medicine

 

 
Tranylcypromine

View adult BNF View SPC online View childrens BNF
Non Formulary

No longer initiated due to higher cost

 
Trifluoperazine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Trimipramine

View adult BNF View SPC online View childrens BNF
Non Formulary

Removed from formulary, Low Value Medicine, safer alternatives

 

 
  
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

Green

Suitable for use in primary care  

Amber

Specialist initiation. Shared care in place  

Red

Red do not use..  

Advice

Some formulations restricted  

Black

NICE "Do not do"  

Green 1

1st line option  

Green 2

2nd line option  

Green 3

3rd line option only  

Not Recomended / Black

Low Value Medicine not recommended for use - see NHSE guidelines  

OTC

This preparation should be bought over the counter for self-care  

Red Amber

Check product description for traffic light status  

Red Black

Low Value Medicine  

netFormulary