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

Opioid Resource Pack

Gabapentinoid Reduction Leaflet

 Details...
04.07.02  Expand sub section  Opioid analgesics
Codeine
(analgesia)
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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®)
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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®)
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First Choice
Green

Immediate release (IR) for titration and breakthrough pain

 

 

 
Controlled Drug Morphine Salts (Sevredol®)
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First Choice
Green

Immediate release (IR) for titration and breakthrough pain

 

 
Controlled Drug Buprenorphine (Butec® patch)
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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
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Second Choice
Green 2

Known to be misused and subject to drug seeking behaviour.

 
   
Controlled Drug Fentanyl (Matrifen)
(Patch)
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Third Choice
Green 3

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

MATRIFEN is HCCG brand of choice

 
   
Controlled Drug Tramadol
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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®)
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Formulary
Green
 
   
Controlled Drug Diamorphine Hydrochloride Injection
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Formulary
Green
 
   
Controlled Drug Fentanyl Nasal Spray (PecFent®)
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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®)
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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
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Restricted Drug Restricted
Red

Injection for maternity inpatient use only.

 

 
   
Controlled Drug Oxycodone modified release tablets
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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®)
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Restricted Drug Restricted
Amber

 Specialist initiation only by pain consultant

 
   
 ....
 Non Formulary Items
Controlled Drug  Alfentanyl Sublingual Spray 5 mg in 5mL

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Non Formulary
 
Controlled Drug  Dihydrocodeine Tartrate  (DHC Continus®)

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Non Formulary
 
Controlled Drug  Dipipanone  (Diconal®)

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Non Formulary
 
Controlled Drug  Fentanyl
(Actiq lozenges)

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Non Formulary
 
Controlled Drug  Fentanyl  (Effentora® buccal tablets)

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Non Formulary
 
Controlled Drug  Fentanyl  (Instanyl® nasal spray)

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Non Formulary
 
Controlled Drug  Hydromorphone  (Palladone®)

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Non Formulary
 
Meptazinol  (Meptid®)

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Non Formulary
 
Controlled Drug  Morphine and cyclizine  (Cyclimorph®)

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Non Formulary
 
Controlled Drug  Morphine Salts  (MST Continus®)

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Non Formulary

Except 5mg tablets

 
Controlled Drug  Morphine suppositories

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Non Formulary
 
Controlled Drug  Papaveretum

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Non Formulary
 
Controlled Drug  Papaveretum
(Papaveretum with hyoscine injection)

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Non Formulary
 
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

 
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  Tramadol Hydrochloride and paracetamol  (Tramacet®)

View adult BNF View SPC online View childrens BNF
Non Formulary

See Herefordshire LPT Low Value Medicine

 

 
  
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
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
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  

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