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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.01  Hypnotics and anxiolytics
 note 

Hypnotics should not be prescribed for more than 10 nights without being reviewed.
Use in the elderly is discouraged.
Nitrazepam is no longer included in the formulary for use as a hypnotic

04.01.01  Hypnotics
Melatonin
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Formulary
  • First line: melatonin 1mg and 5mg modified release tablets in line with licensed indications only.
  • Second line: melatonin 1mg, 2mg, 3mg, 4mg and 5mg tablets (crushed if necessary).
  • Third line: melatonin 1mg/1ml oral solution (alcohol-free) - for patients unable to use crushed tablets

Approved Indications

Melatonin can be used to facilitate the induction of sleep, and increase the duration of sleep on the advice of an appropriate secondary care specialist, in the following situations:

1) Visually impaired or blind people with disturbed sleep wake cycles. Green plus
2) Delayed sleep phase syndrome and other circadian rhythm disorders.Green plus
3) Children with neurological or behavioural disorders including: Amber

  • Attention deficit hyperactivity disorder (ADHD).*
  • Chronic sleep onset insomnia.*
  • Neurodevelopmental disabilities (e.g. involving delayed brain maturation, sensory dysfunction - especially visual and dysfunction of sleep centres).*

4) Treatment of children and young adults with chronic fatigue syndrome / myalgic encephalomyelitis who have sleep difficulties (as recommended in NICE clinical guideline no. 53).* Amber
5) Prior to examinations such as a sleep encephalogram (EEG) in children and sedation prior to scans in paediatric oncology. Green plus
6) Patients with REM sleep behaviour disorder (RBD) - e.g. associated with degenerative conditions such as Parkinson’s disease or dementia, as a second line treatment to clonazepam. Green plus
7) To improve nocturnal sleep in critically ill patients (to aid weaning from mechanical ventilation) Green plus

*Note that for indications 3 and 4 in children and young people melatonin is classified as an ‘amber’ drug and therefore subject to formal shared care guidance.  Please follow relevant link below for the most recent guideline.

 
Link  Tees, Esk and Wear - Melatonin Shared Care Guideline
Link  North of Tyne, Gateshead and North Cumbria - Melatonin for the management of Sleep – Wake Disorders in Children and Young People
Link  North of Tyne, Gateshead and North Cumbria - Melatonin Deprescribing Guideline (March 2022)
 
04.01.01  Benzodiazepines
Controlled Drug Temazepam
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First Choice
Green
 
04.01.01  Zaleplon, Zolpidem and Zopiclone
Zolpidem
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  MHRA Drug Safety Update (May 2014): Zolpidem: risk of drowsiness and reduced driving ability
Link  NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
 
Zopiclone
View adult BNF View SPC online
Formulary
Green
  • To be used in accordance with NICE criteria
 
Link  NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
 
04.01.01  Chloral and derivatives to top
Chloral Hydrate
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
Link  MHRA Drug Safety Update (Oct 2021): Chloral hydrate, cloral betaine (Welldorm): restriction of paediatric indication
 
Chloral Hydrate 500mg in 5ml mixture
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
Link  MHRA Drug Safety Update (Oct 2021): Chloral hydrate, cloral betaine (Welldorm): restriction of paediatric indication
 
04.01.01  Clomethiazole (Chlormethiazole)
Clomethiazole
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Formulary
Green

  • Alcohol withdrawal - chlordiazepoxide is preferred in the management of alcohol withdrawal.

 
 
04.01.01  Antihistamines
Promethazine Hydrochloride
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Formulary
Green
 
 
04.01.01  Daridorexant
Daridorexant (Quviviq® )
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 25mg and 50mg tablets
  • Approved for the treatment long-term insomnia in line with NICE via NHS Sleep Clinic at
    • South Tees Hosptials NHS Foundation Trust; and 
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust
  • First 3 months treatment to be provided by secondary care followed by a review and a further 1 month supply if appropriate before prescribing is handed over to primary care
 
Link  NICE TA922: Daridorexant for treating long-term insomnia
 
04.01.01  Sodium oxybate
Controlled Drug Sodium Oxybate 500mg/1ml oral solution (Xyrem®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Approved for the treatment of narcolepsy with cataplexy in children age 7 years and above only in accordance with NHS England clinical commissioning policy.
  •  The Northern (NHS) Treatment Advisory Group recommends the use of sodium oxybate in adult patients who have received and benefited from treatment with sodium oxybate as commissioned by NHS England. i.e. continuing treatment for those >19 years old.
  • The Northern (NHS) Treatment Advisory Group also recommends sodium oxybate for use in adults who have not received it as a child as per the RMOC criteria, noting that may sometimes be used in combination with other agents.
  • The following criteria for use in adults who have not received sodium oxybate as child apply:
    • Patients presenting with narcolepsy with cataplexy according to International Classification of sleep disorders 3 (ICSD) criteria for Narcolepsy Type 1 AND
    • Patients ≥ 19 years old AND
    • Where patients have co-morbidities, which are also affecting sleep, these should be managed and adequately treated (for example moderate to severe obstructive sleep apnoea or restless legs syndrome) AND
    • Failure to respond to non-pharmacological treatments consisting of behavioural and environmental adaptations, for example planned naps AND
    • Inadequate response (within 3 months) to, or intolerable adverse effects from, or contra-indicated use of, more than one stimulant for narcolepsy, and more than one anticataplectic agent AND
    • Assessed as being able to benefit from sodium oxybate via a specialist sleep centre.
  • Sodium oxybate is generally considered as a final treatment option for patient
 
Link  Clinical Commissioning Policy: Sodium oxybate for symptom control of narcolepsy with cataplexy (children and adolescents aged 7 until 19 years)
Link  NTAG - Treatment Appraisal Decision Summary - Sodium Oxybate
 
04.01.01  Pitolisant to top
04.01.02  Anxiolytics
 note 

Benzodiazepines should not be used as an anxiolytic for more than 4 weeks without being reviewed. Use in the elderly is discouraged.

Pregabalin
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Formulary
Green plus
 
Link  MHRA Drug Safety Update (Apr 2022): Pregabalin (Lyrica): findings of safety study on risks during pregnancy
Link  MHRA Drug Safety Update (Feb 2021): Pregabalin (Lyrica): reports of severe respiratory depression
 
04.01.02  Benzodiazepines
Diazepam
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First Choice
Green
  • Diazepam 2mg tablets: are the preferred strength in primary care. 
  • Diazepam 10mg tablets: should no longer be used. 
  • Diazepam 10mg in 2ml injection: only approved for use in epilepsy (see section 4.8.2).
  • Diazepam 2 mg/5ml oral solution: swallowing difficulties
 
Chlordiazepoxide
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Formulary
Green
 
 
Lorazepam
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Formulary
Green
 
Link  MHRA Drug Safety Update (October 2007): Lorazepam: reduction of recommended maximum daily dose
 
04.01.02  Buspirone
Buspirone Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
04.01.02  Beta blockers
04.01.02  Meprobamate to top
04.01.03  Barbiturates
04.02  Drugs used in psychoses and related disorders
04.02.01  Antipsychotic Drugs
 note 

For more information on prescribing antipsychotics in primary care see the North of Tyne, Gateshead and North Cumbria APC Information leaflet prepared by CNTW or the TEWV Medicines Optimisation Interactive Guide (as appropriate):

Antipsychotic Drugs – Prescribing & Monitoring in Adults - Information for Primary Care

TEWV Medicines Optimisation Interactive Guide

Benperidol
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Formulary
Green plus
  • Approved for the control of deviant antisocial sexual behaviour
 
 
04.02.01  First Generation Antipsychotic Drugs
Chlorpromazine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Haloperidol
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Green Palliative Care
 
Link  MHRA Drug Safety Update Dec 2021: Haloperidol (Haldol): reminder of risks when used in elderly patients for the acute treatment of delirium
Link  NICE NG10: Violence and aggression: short-term management in mental health, health and community settings
Link  TEWV Rapid Tranquilisation Policy
 
Perphenazine
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Formulary
Green plus
 
 
Sulpiride
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Zuclopenthixol
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Flupentixol
(Flupenthixol)
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
 
 
Levomepromazine
(Methotrimeprazine)
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Green For use in palliative care.
    • Levomepromazine 25mg in 1ml injection is approved for use in palliative care. 
  • Note: Methotrimeprazine / Levomepromazine 6mg tablets are unlicensedunlicense
 
 
Trifluoperazine
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Alternatives
Green plus
 
 
04.02.01  Second Generation Antipsychotic Drugs to top
Risperidone
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Formulary
Green plus
  • Note: risperidone orodispersible tablets should only be used in situations where the plain tablets are unsuitable.
 
Link  MHRA Drug Safety Update (Nov 2013): Risperidone and paliperidone: risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery
 
Amisulpride
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Formulary
Green plus
 
 
Aripiprazole
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Alternatives
Green plus

  • Approved for schizophrenia in people aged 15 to 17 years in line with NICE.

  • Approved for moderate to severe manic episodes in young people aged 13 and older with bipolar I disorder NICE.

  • Aripriprazole 10mg & 15mg orodispersible tablets are approved for doses over 5mg for those patients who have difficulty swallowing.

  • Aripiprazole 1mg in 1ml oral solution is only for doses of 5mg or less, or when titrating patients on doses of increments of less than 5mg, in patients who have difficulty swallowing tablets.

  • To be used in accordance with NICE criteria.

  • Note: Aripiprazole 7.5mg/ml IM Injection is approved for use in rapid tranquilisation in patients with acute psychosis. Red Traffic Light NTW use only.


 

 
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
Link  NICE TA292: Bipolar disorder (children) - aripiprazole
 
Clozapine
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Alternatives
Red
  • First choice in patients with treatment-resistant schizophrenia. 
 
Link  MHRA Drug Safety Alert (Oct 2017): Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
Link  MHRA Drug Safety Update (Aug 2020): Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
 
Lurasidone (Latuda®)
View adult BNF View SPC online View SMC online View childrens BNF
Alternatives
Green plus

  • 18.5mg, 37mg and 74mg tablets

  • Approved for the treatment of schizophrenia in adults and adolescents aged 13 years and over 

 
Link  NTAG - Lurasidone Treatment Appraisal: Decision Summary
 
Olanzapine
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Alternatives
  • Olanzapine orodispersible tablets should only be used in situations where the plain tablets are unsuitable. 
  • Olanzapine orodispersible tablets and injection are also approved for 2nd/3rd- line use in the management of delirium in critical care patients unlicensedunlicensed indication. Green plus
  •  10 mg injection Green plus
    • for rapid control of agitation and disturbed behaviours in patients with schizophrenia or manic episode, when oral therapy is not appropriate.
    • for delirium at end of life 
  • 210mg, 300mg & 405mg powder and solvent for suspension for long-acting injection (as olanzapine embonate monohydrate) Red

    • approved for the treatment of schizophrenia in adults within secure psychiatric services


 
 
Quetiapine
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Alternatives

  • 25mg, 100mg, 150mg 200mg & 300mg tablets Green plus

  • 50mg, 200mg, 300mg & 400mg prolonged release tablets Green plus 


    • Prolonged release tablets are approved for use in patients who require an outside carer to administer their medicines, and for short term use when rapid dose titration is considered important e.g. where its use might avoid the need to admit the patient to hospital.



  • Quetiapine 20mg/ml Oral Suspension (Rosemont) - CNTW only Red 


 

 
 
04.02.02  Antipsychotic depot injections
 note 

For detailed information on prescribing long-acting antopsychotic injections, see the following North of England information sheet.

Guidance on the Use of Antipsychotic Long-acting Injections in North of England

 

Zuclopenthixol Decanoate
View adult BNF View SPC online View childrens BNF
First Choice
  • Green plus CNTW
  • Amber TEWV
 
Aripiprazole (Abilify Maintena®)
View adult BNF View SPC online View childrens BNF
Alternatives
  • Green plus CNTW
  • Amber TEWV
  • NTAG approved for the treatment of schizophrenia as per its licensed indication and as outlined in the Guidance on the Use of Antipsychotic Long-acting Injections in the North of England.
 
Link  Aripiprazole (Abilify Maintena®, Otsuka Pharmaceuticals) long acting injection for schizophrenia
Link  TEWV Shared Care Guidelines for Aripiprazole
 
Flupentixol Decanoate
View adult BNF View SPC online View childrens BNF
Alternatives
  • Green plus CNTW
  • Amber TEWV
 
 
Haloperidol Decanoate
View adult BNF View SPC online View childrens BNF
Alternatives
  • Green plus CNTW
  • Amber TEWV
 
 
Paliperidone
View adult BNF View SPC online View childrens BNF
Alternatives
  • Green plus CNTW
  • Amber TEWV
  • NTAG approved for the treatment of schizophrenia as per its licensed indication and as outlined in the Guidance on the Use of Antipsychotic Long-acting Injections in the North of England.
 
Link  Paliperidone long acting injection (Xeplion®) and Paliperidone 3 monthly injection (Trevicta®) Janssen-Cilag for schizophrenia.
Link  TEWV Paliperidone LAI – Shared Care Guidelines
 
Risperidone (Risperdal Consta®)
View adult BNF View SPC online View childrens BNF
Alternatives
  • Green plus CNTW
  • Amber TEWV
  • Only for use by psychiatrists in accordance with NTAG guidelines.

 

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

  • For short-term use by NTW.

 
 
Olanzapine Embonate (ZypAdhera®)
View adult BNF View SPC online View childrens BNF
Alternatives
Red
 
 
04.02.03  Drugs used for mania and hypomania
 note 

Other anticonvulsant drugs are used in the management of bipolar disorders e.g. Lamotrigine for the depressive phase. Such use is ‘off-licence’.

Lamotrigine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Olanzapine (oral)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Quetiapine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Risperidone (oral)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
Link  MHRA Drug Safety Update (Nov 2013): Risperidone and paliperidone: risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery
 
04.02.03  Benzodiazepines
04.02.03  Antipsychotic drugs
04.02.03  Carbamazepine to top
Carbamazepine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
04.02.03  Valproic acid
 note 

Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP)

Sodium valproate 200mg, 300mg, and 500mg tablets (Epilim Chrono®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Sodium valproate 200mg, 300mg, and 500mg (Epilim Chrono®) tablets are approved for the prevention and treatment of manic episodes associated with bipolar disorder (unlicensedunlicensed indication). May be useful in patients unresponsive to lithium. 

Valproate must no longer be prescribed to women and girls of childbearing potential unless there is no alternative and they are on the Pregnancy Prevention Programme (PPP) Amber

Black Triangle in females

For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:

MHRA Drug Safety Updates (valproate)

 
Link  Valproate medicines: Pregnancy Prevention Programme materials
 
Valproic Acid  (Depakote®)
(Semisodium valproate)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Licensed alternative to sodium valproate MR tablets. 

Valproate must no longer be prescribed to women and girls of childbearing potential unless there is no alternative and they are on the Pregnancy Prevention Programme (PPP) Amber

▼Black Triangle in females

For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:

MHRA Drug Safety Updates (valproate)

 
Link  Valproate medicines: Pregnancy Prevention Programme materials
Link  Local Shared Care guideline in TEWV to support Valproate Pregnancy Prevention Programme
 
04.02.03  Lithium
Lithium Carbonate
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • Prescribe by brand name.
 
Link  North of Tyne, Gateshead and North Cumbria - Lithium Shared Care Guideline
Link  South Tyneside & Sunderland APC Shared Care Guideline - Lithium
Link  TEWV Guidelines on Safe Lithium Prescribing and Shared Care
Link  TEWV Safety guidance: Lithium on admission to an acute hospital ward
 
Lithium Citrate
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • Prescribe by brand name.
 
Link  North of Tyne, Gateshead and North Cumbria - Lithium Shared Care Guideline
Link  TEWV Guidelines on Safe Lithium Prescribing and Shared Care
Link  TEWV Safety guidance: Lithium on admission to an acute hospital ward
 
04.03  Antidepressant drugs
04.03.01  Tricyclic and related antidepressant drugs
04.03.01  Tricyclic antidepressants to top
Amitriptyline
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First Choice
Green
 
Imipramine
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Formulary
Green
 
 
Lofepramine
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Formulary
Green
  • Safer than amitriptyline in overdosage, but not as effective.
 
 
Clomipramine
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Alternatives
Green
 
 
04.03.01  Related antidepressants
Trazodone
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • Trazodone is widely used off-license for night sedation and behavioural symptoms of dementia.
 
04.03.02  Monoamine-oxidase inhibitors
Phenelzine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • For use on advice from psychiatrists only.
 
 
04.03.02  Reverible MAOIs
Moclobemide
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • For use on advice from psychiatrists only.
 
 
04.03.03  Selective serotonin re-uptake inhibitors
Citalopram
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • Please note maximum doses
    • Adults = 40mg
    • Elderly = 20mg
 
Fluoxetine
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 20mg capsules
  • 20mg dispersible tablets
    • first choice for patients unable to use the capsules
  • 20mg/5ml oral solution
 
Paroxetine
View adult BNF View SPC online View childrens BNF
First Choice
Green
 
Sertraline
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • 25mg, 50mg, 100mg, 150mg & 200mg tablets
  • 100mg/5ml concentrate for oral solution (Thame)
    • Approved for patients who are unable to take a solid dose form or who require small doses 
    • Must be diluted prior to use. Please refer to SPC for list of specified drinks
 
Escitalopram
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  MHRA Drug Safety Update (Dec 2014): Citalopram and escitalopram: QT interval prolongation
Link  MHRA Drug Safety Update (Jan 2021): SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery
 
04.03.04  Other antidepressant drugs to top
 note 

These drugs are for use in patients not responding adequately to first-line treatments.

Agomelatine
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • NETAG approved for the treatment of depression only following an adequate trial of at least three alternative antidepressant drugs at maximally tolerated doses (as described by NICE and as stated in the BNF).

 

  • Prescribing and monitoring should be initiated by specialist mental health physicians. After a minimum of 12 weeks, prescribing may be transferred to primary care. 
 
Link  MHRA Drug Safety Update (Dec 2014): Agomelatine (Valdoxan): risk of liver toxicity
Link  North of Tyne, Gateshead and North Cumbria Area Prescribing Committee - Agomelatine – Prescribing and Monitoring in Adults: Information for Primary Care
 
Duloxetine
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • For use on advice of psychiatrists as a third-line antidepressant - but only for use in patients who cannot tolerate high-dose (>150mg daily) venlafaxine, or patients with hypertension, established CHD or other cardiovascular risk factors which would make the use of high-dose venlafaxine undesirable.
    Also approved for third-line use (after drugs such as the tricyclic antidepressants and gabapentin) in the treatment of neuropathic pain on the advice of pain specialists.
 
 
Mirtazapine
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • Orodispersible mirtazapine tablets should only be prescribed for use when other formulations are unsuitable (more expensive).
 
 
Reboxetine
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus

 

    • Not licensed in the elderly

 

 
 
Venlafaxine
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • For patients on doses of 300mg/day or more. Green Traffic Light
  • Patients who are deemed stable on doses of up to 225mg daily of MR venlafaxine should be switched to the equivalent dose of immediate release venlafaxine.
  • MR tablets are only to be used in patients currently prescribed doses of 300mg and over and for whom there is no suitable alternative, those who have experienced discontinuation reactions (at any dose), and for patients who need to take the once daily formulation in order to facilitate care visits.
 
Link  TEWV Depression medication pathway for adults
 
Vortioxetine
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Alternatives
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA367: Vortioxetine for treating major depressive episodes
 
04.04  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
Controlled Drug Methylphenidate
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • Please prescribe by brand name
  • Approved for ADHD and the treatment of narcolepsy in adult and paediatrics.
  • Approved for improving working memory and processing speed following neurocognitive damage secondary to brain injury from; a brain tumour and its associated treatment (e.g. hydrocephalus and radiotherapy) or neurotoxic chemotherapy.
    • 5mg & 10mg tablets
    • 5mg, 10mg, 20mg, 30mg and 40mg m/r capsules (Medikinet® XL)
    • 10mg, 20mg & 30mg m/r capsules (Equasym® XL)18mg, 27mg & 36mg m/r tablets (Xaggitin® XL)
        • Existing patients who are prescribed Concerta® XL should be reviewed and switched to Xaggitin® XL as appropriate
        • Xaggitin® XL is bioequivalent to Concerta® XL
 
Link  North of Tyne, Gateshead and North Cumbria - Methylphenidate for Narcolepsy Shared Care Guidance (March 2023)
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Methylphenidate secondary to brain injury
Link  South Tyneside & Sunderland APC Shared Care Guidance - Methylphenidate, Dexamfetamine, Lisdexamfetamine and Atomoxetine for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  South Tyneside & Sunderland APC Shared Care Guidance - Methylphenidate, Dexamfetamine, Lisdexamfetamine, Atomoxetine and Guanfacine for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  TEWV ADHD prescribing algorithm in adults
Link  TEWV ADHD prescribing algorithm in Children & Young People
Link  TEWV Methylphenidate Shared Care Guideline
 
Atomoxetine
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • 10mg, 18mg, 25mg, 40mg, 60mg, 80mg & 100mg capsules
  • 4mg/1ml oral solution - approved for patients with more complex needs e.g. younger patients and those with swallowing difficulties.

 

 
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  TEWV Atomoxetine Shared Care Guideline
 
Controlled Drug Dexamfetamine
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • 5mg, 10mg and 20mg tablets
    • ADHD
    • Narcolepsy
    • Doses up to 60mg daily 

 

 
Link  North of Tyne, Gateshead and North Cumbria - Dexamfetamine for Narcolepsy
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  TEWV Shared Care Guidelines: Dexamfetamine
 
Controlled Drug Lisdexamfetamine
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • 20mg, 30mg, 40mg, 50mg, 60mg & 70mg capsules
    • For third line use and specialist initiation. Should only transferred to GPs after at least three month stable symptom control
    • Approved for the treatment of ADHD in adults



 

 
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  TEWV Shared Care Guidelines: Lisdexamfetamine
 
Modafinil
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Formulary
Green plus
  • Approved for:
    • treatment of patients with narcolepsy
    • treatment of idiopathic hypersomnia


 

 
Link  MHRA Drug Safety Update (Nov 2020): Modafinil (Provigil): increased risk of congenital malformations if used during pregnancy
 
Solriamfetol Black Triangle (Sunosi®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
  • 75mg and 150mg tablet
    • Approved for treating excesive daytime sleepiness caused by narcolepsy in line with NICE

 

 

 
Link  NICE TA758: Solriamfetol for treating excessive daytime sleepiness caused by narcolepsy
Link  NICE TA777: Solriamfetol for treating excessive daytime sleepiness caused by obstructive sleep apnoea (Not Recommended)
 
Pitolisant (Wakix®)
View adult BNF View SPC online View childrens BNF
Alternatives
Red
CCG
  • Approved for use in patients with narcolepsy who experience psychomotor side effects with modafinil and dexamfetamine.
  • To be used in line with NTAG

 

 
Link  NICE TA776: Pitolisant hydrochloride for treating excessive daytime sleepiness caused by obstructive sleep apnoea
Link  NTAG - Treatment Appraisal Decision Summary - Pitolisant (Wakix®) for the treatment of narcolepsy with or without cataplexy in adults.
Link  NTAG - Pitolisant for Narcolepsy Treatment Pathway
 
Guanfacine (Intuniv®)
View adult BNF View SPC online View childrens BNF
Alternatives
Amber
  • 1mg, 2mg, 3mg & 4mg prolonged release tablets
    • Approved for use in children and adolescents when 1st line stimulants and atomoxetine are contraindicated or ineffective.
    • Can also be prescribed in primary care by GPs in adults who started treatment in childhood and wish to continue, for whom stimulants are not suitable, not tolerated or have been shown to be ineffective under specialist supervision

 

 
Link  Methylphenidate, Dexamfetamine, Lisdexamfetamine and Atomoxetine for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  TEWV ADHD prescribing algorithm in adults
Link  TEWV Guanfacine Shared Care Guideline
 
04.04  Cocaine
04.05  Drugs used in the treatment of obesity
04.05.01  Anti-obesity drugs acting on the gastro-intestinal tract
Liraglutide (Saxenda®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

 Saxenda®Red

  • Approved as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults in line with NICE and providing: 
    • it is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service; and
    • the company provides it according to the commercial arrangement 
 
Link  NICE TA664: Liraglutide for managing overweight and obesity
 
Orlistat
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  MHRA Drug Safety Update (March 2014): Orlistat: theoretical interaction with antiretroviral HIV medicines
 
04.05.02  Centrally acting appetite suppressants to top
04.06  Drugs used in nausea and vertigo
Droperidol
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Granisetron
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Metoclopramide INJECTION
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Palliative care use
 
 
Nabilone
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Ondansetron INJECTION
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Palliative care use
 
Link  MHRA Drug Safety Alert (Jul 2013): Ondansetron for intravenous use: dose-dependent QT interval prolongation
Link  MHRA Drug Safety Update (Jan 2020): Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy
 
04.06  Vomiting during pregnancy
04.06  Postoperative nausea and vomiting
04.06  Motion sickness
04.06  Other vestibular disorders to top
04.06  Cytotoxic chemotherapy
04.06  Palliative care
04.06  Migraine
04.06  Antihistamines
Cinnarizine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Cyclizine
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Promethazine Hydrochloride (Phenergan)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
04.06  Phenothiazines and related drugs to top
Prochlorperazine
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Note: Buccastem® 3mg tablets are only approved for the treatment of nausea associated with migraine when the oral route cannot be used due to vomiting.
 
 
04.06  Domperidone and metoclopramide
Metoclopramide
View adult BNF View SPC online View childrens BNF
Formulary
Green

  • Please refer to MHRA advice 

 
Link  Metoclopramide: risk of neurological adverse effects
 
Domperidone
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
  • Approved for use as a galactagogue to re-establish breastfeeding on specialist advice and following a cardiovascular risk assessment in light of MHRA advice.
 
Link  MHRA Drug Safety Alert (May 2014): Domperidone: risk of cardiac side effect
Link  MHRA Drug Safety Update (Dec 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents
 
04.06  5HT3 antagonists
Ondansetron
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • The cheapest available formulation should be used.
  • Ondansetron 4mg and 8mg oro-dispersible tablets/films are approved for the treatment of post-operative nausea and vomiting in patients who do not require IV access or are nil by mouth Red Traffic Light   

 
Palonosetron
View adult BNF View SPC online View childrens BNF
Alternatives
Red
  • Only approved for the second line treatment of chemotherapy induced nausea vomiting only.
 
 
Netupitant & Palonosetron (Akynzeo®)
View adult BNF View SPC online View childrens BNF
Alternatives
Red

  • To be used in accordance with Northern England Strategic Clincial Cancer Network (NCCN) Guidelines

 
 
04.06  Neurokinin receptor antagonist
Aprepitant
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • For the prevention of chemotherapy induced nausea and vomiting (CINV) in high risk patients in accordance with North of England Cancer Network: CINV Guidelines in adult oncology and haematology patients
 
Link  Chemotherapy Induced Nausea and Vomiting (CINV) Anti-emetic Guidelines
 
Fosaprepitant
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • For the prevention of chemotherapy induced nausea and vomiting (CINV) in high risk patients in accordance with North of England Cancer Network: CINV Guidelines in adult oncology and haematology patients
 
Link  Chemotherapy Induced Nausea and Vomiting (CINV) Anti-emetic Guidelines
 
04.06  Cannabinoid
Controlled Drug Cannabidiol  (Epidyolex®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England

  • 100mg/1mL oral solution

    • Approved for use in combination with clobazam for treating seizuires associated with Dravet syndrome in people aged 2 years and older

    • Approved for use in combination with clobazam for treating seizures associated with Lennox-Gastaut syndrome



 
Link  NICE TA614: Cannabidiol with clobazam for treating seizures associated with Dravet syndrome
Link  NICE TA615: Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome
 
04.06  Hyoscine to top
Hyoscine Hydrobromide
(tablets/patches)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • For the management of excessive secretions where tablets are unsuitable.
 
 
04.06  Other drugs for Ménière's disease
Betahistine Dihydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
04.07  Analgesics
04.07.01  Non-opioid analgesics and compound analgesic preparations
Paracetamol
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • Paracetamol 500mg tablets / soluble tablets
  • Paracetamol 1gram injection for IV infusion Red 
    • NoTGhdNC: approved for limited short-term use where oral and rectal routes cannot be used and NSAIDs are not appropriate in paediatric areas only, the 50ml formulation should be stocked.
  • Paracetamol suppositories
  • Licensed preparations include 60mg,125mg, 250mg, and 500mg suppositories are available in primary care.
  • unlicensed unlicensed preparations include 15mg, 30mg, 60mg, 120mg, 240mg, and 500mg. These are used in NUTH.
 
Naproxen tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Ibuprofen
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
Link  MHRA Drug Safety Update (June 2015): High-dose ibuprofen (≥2400mg/day): small increase in cardiovascular risk
 
Aspirin
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Diclofenac
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Oral diclofenac is restricted to short-term use for post operative pain.
  • If long-term use is required diclofenac is only approved for 4th line treatment (see below):
    • Ibuprofen low dose – first line treatment.
    • Naproxen low dose – second line treatment.
    • Naproxen high dose – third line treatment.
    • Diclofenac – fourth line treatment.
 
Link  MHRA Drug Safety Update (Dec 2007): NSAIDs and coxibs: balancing of cardiovascular and gastrointestinal risks
Link  MHRA Drug Safety Update (Jan 2015): Cox-2 selective inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs): Cardiovascular safety.
Link  MHRA Drug Safety Update (June 2013): Diclofenac: new contraindications and warnings
Link  MHRA Drug Safety Update (Oct 2012): Non-steroidal anti-inflammatory drugs (NSAIDs): cardiovascular risks
 
04.07.01  Compound analgesic preparations
 note 

While Co-codamol 8/500 is commonly used, no advantages over paracetamol have been substantiated. The low dose of codeine may be enough to cause opioid side-effects (in particular, constipation) and can complicate the treatment of overdose, yet may not provide significant additional relief of pain. Use is therefore discouraged.

04.07.02  Opioid analgesics to top
 note 

North East North Cumbria (NENC) ICB Medicines Committee Position Statement on Prescribing in Persistent Pain

NENC ICB DOES NOT support the routine long-term prescribing (greater than 3 months) of opioids or the use of high dose opioids (higher than 120 mg/day of oral morphine equivalent) for non-cancer, persistent pain in adults.

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

First line

  • 15mg tablets

Second line

  • 30mg tablets

The following codeine preparations are unlicensedunlicensed and approved for use:

  • 30 mg suppositories.
  • codeine 2mg, 3mg, 6mg, 15mg;
  • codeine 30mg in 1ml injection CD
 
Link  MHRA Drug Safety Update (Dec 2014): Codeine for analgesia: restricted use in children because of reports of morphine toxicity
Link  MHRA Drug Safety Update (Dec 2014): Codeine: very rare risk of side-effects in breastfed babies
 
Controlled Drug Morphine
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Tablets - 10mg, 20mg, 50mg (Sevredol®)
  • MR capsules - 10mg, 30mg, 60mg, 100mg, 200mg (Zomorph®)
  • MR tablets -  5mg, 10mg, 15mg, 30mg, 60mg, 100mg, 200mg (MST®)
  • Oral solution - 10mg in 5ml
  • Injection - 10mg/ml, 15mg/ml, 20mg/ml, 30mg/ml
  • Zomorph® is the preferred M/R formulation. 
  • Red Note: the following preparations are also approved for use:
    • morphine 5mg in 1ml injection   unlicensedunlicensed 
    • 10mg in 1ml preservative free injection   unlicensedunlicensed 
    • 2mg in 5ml epidural   unlicensedunlicensed 
    • 100 micrograms/1 ml oral solution. For use in neonates.   unlicensedunlicensed 
    • 50mg in 50ml PCA injection  
 
 
Alfentanil
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Palliative care use Green plus 
  • 500micrograms in 1ml [ST&S], 1mg in 2ml, 5mg in 10ml & 5mg in 1ml injection ampouless - approved for initiation by specialists in palliative care Green plus 
  • All non-palliative care indications Red
 
 
Controlled Drug Diamorphine
View adult BNF View SPC online View childrens BNF
Formulary
Red

 

    • unlicensed Unlicensed intranasal diamorphine is approved for use in children for the relief of severe pain due to clinically suspected limb fractures, burns and significant fingertip injuries. Appropriate risk assessments are to be conducted by each organisation in order to determine formulation of choice (e.g. ampoules or intranasal spray).

 

    • Note: intranasal diamorhine Red Traffic Light  

 

 
 
Ketamine
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Controlled Drug Tramadol
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 50mg capsules, 50mg dispersible tablets & 100mg/2ml injection
  • Only approved for use as a second-line weak opioid analgesic for use in patients where treatment with possible alternatives such as paracetamol, NSAIDs, and codeine is insufficiently effective, not tolerated or considered unsuitable for other reasons.
  • Note: modified release tramadol is not approved or recommended. 
 
 
Controlled Drug Buprenorphine
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • 200microgram sublingual tablets
  • 300microgram in 1ml injection
  • Buprenorphine patches (Preferred brand - Butec®) are approved for use in palliative care when fentanyl 12 microgram/hr transdermal patches exceed the patient’s analgesic requirements.
 
 
Controlled Drug Fentanyl
View adult BNF View SPC online View childrens BNF
Alternatives
  • 12, 25, 50, 75 & 100 microgram/hour transdermal patches Green Traffic Light
    • Prescribe by brand. Mezolar® has replaced Matrifen® as the first choice brand. Patients who currently use Matrifen® can continue to do so if managing well.
  • Fentanyl sublingual tablets (Abstral®) NoTGhdNC Red only for patients experiencing incident pain during radiotherapy, restricted to palliative care use only 
  • Fentanyl sublingual tablets (Abstral®) CD&TV Green plus for breakthrough / rescue pain relief in palliative care
  • nasal spray Red
    • approved for use in children during diamorphine shortage with appropriate local governance arrangements
 
Link  MHRA Drug Safety Update (Oct 2018): Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure, particularly in children
Link  MHRA Drug Safety Update (Sep 2020): Transdermal fentanyl patches for non-cancer pain: do not use in opioid-naive patients
Link  Transdermal fentanyl – MHRA Drug Safety Update (July 2014): Transdermal fentanyl “patches”: reminder of potential life threatening harm from accidental exposure, especially in children
 
Controlled Drug Hydromorphone
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
 
 
Controlled Drug Methadone
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus

The following preparations are approved:

  • 5mg tablets;
  • 5mg in 5ml mixture DTF & 5mg in 5ml sugar free solution
  • 20mg in 1ml concentrated oral solution (unlicensedunlicensed)
  • 10mg in 1ml injection



 
 
Controlled Drug Oxycodone
View adult BNF View SPC online View childrens BNF
Alternatives
  • Approved only for use in patients who are intolerant of morphine. Green
    • Note: Oxycodone 50mg in 1ml injection  is also approved for use, but is restricted to controlled circumstances in palliative patients following risk assessment by individual organisations.Green Traffic Light
  • Approved for use as part of Enhanced Recovery After Surgery (ERAS) as part of multi-modal enhanced recovery pathway following hip and knee surgery Red
    • The OxyPro® branded generic is preferred (most cost effective option). 
    • The oral solution should be used instead of immediate release tablets. 
 
 
Controlled Drug Pethidine
View adult BNF View SPC online View childrens BNF
Alternatives
Red
 
 
Controlled Drug Tapentadol
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Approved for use by chronic pain specialist in adults with severe pain who have been screened for a neuropathic element to their pain and are uncontrolled or experiencing GI side effects on existing therapy.
 
Link  MHRA Drug Safety Update (Jan 2019): Tapentadol (Palexia): risk of seizures and reports of serotonin syndrome when co-administered with other medicines
 
Controlled Drug Dihydrocodeine
View adult BNF View SPC online View childrens BNF
Alternatives
Red
  • Note: the use of dihydrocodeine 30mg tablets & 10mg in 5ml oral solution is no longer recommended for regular use. Codeine is the preferred weak opioid analgesic.
  • Dihydrocodeine is only approved for use in breast feeding mothers immediately postdelivery/ c-section where adequate pain relief has not been achieved using paracetamol and NSAIDs. Patients requiring contunation of dihydrocodeine following discharge (post delivery/c-section) can have dihydrocodeine prescribed in primary care (for short-term use only).
 
 
04.07.02  Weak opioids
04.07.02  Strong opioids
04.07.02  Breakthrough pain
04.07.02  Injectable
04.07.02  Other to top
04.07.03  Neuropathic pain
 note 

North East North Cumbria (NENC) ICB Medicines Committee Position Statement on Prescribing in Persistent Pain

Prescribing of gabapentinoids to treat persistent non-neuropathic pain is NOT routinely recommended

Note: other drugs such as Ketamine (see section 15.1.1) may also be advised by pain/palliative care specialists in the management of neuropathic pain.

Amitriptyline
View adult BNF View SPC online View childrens BNF
First Choice
Green
 
Gabapentin
View adult BNF View SPC online View childrens BNF
Second Choice
Green
  • For use in the treatment of neuropathic pain
  • Gabapentin is also approved for hospital use  as an adjunct to other treatment in the management of peri/post-operative pain. Red Traffic Light unlicensedunlicensed
  • GPs should not be asked to prescribe gabapentin for this unlicensed indication.
  • Approved for intractable itch with severe burns Green plus

 

 
Link  MHRA Drug Safety Alert (Oct 2017): Gabapentin (Neurontin): risk of severe respiratory depression
 
Pregabalin
View adult BNF View SPC online View childrens BNF
Second Choice
Green
  • Pregabalin is restricted to use in the management neuropathic pain as a second choice where treatment with gabapentin has been unsuccessful or not tolerated.
 
Link  MHRA Drug Safety Update (Apr 2022): Pregabalin (Lyrica): findings of safety study on risks during pregnancy
Link  MHRA Drug Safety Update (Feb 2021): Pregabalin (Lyrica): reports of severe respiratory depression
 
Nortriptyline
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Carbamazepine
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • Restricted use in treatment of trigeminal neuralgia only.
 
 
Duloxetine
View adult BNF View SPC online View childrens BNF
Alternatives
Green

  • For third-line use (after drugs such as the tricyclic antidepressants and gabapentin) in the treatment of neuropathic pain on the advice of pain specialists.

 
 
Phenytoin
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
04.07.03  Trigeminal neuralgia
04.07.03  Postherpetic neuralgia
Capsaicin
View adult BNF View SPC online View childrens BNF
Formulary

  • Qutenza® cutaneous patch approved for the treatment of neuropathic pain as fourth line agent for neuropathic pain and in line with the attached regionally agreed pathway. Red

  • 0.075% cream (Axsain®) approved for post hepatic neuralgia and peripheral diabetic neuropathy Green plus

 
Link  NTAG - Treatment Appraisal Decision Summary - Capsaicin (Qutenza)
Link  NTAG Pathway for the use of Qutenza (Capsaicin 8%) in the Neuropathic Pain Patient Group
 
Lidocaine 5% medicated plasters (700mg lidocaine/plaster)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus

  • For use in the treatment of post-herpetic neuralgia only, on the advice of pain specialists and subject to an appropriate trial of efficacy in each individual patient.

 
Link  Co Durham & Tees Valley APC – Advice on prescribing Lidocaine Patches in Primary Care
 
04.07.03  Chronic facial pain
04.07.04  Antimigraine drugs to top
04.07.04.01  Treatment of the acute migraine attack
Rizatriptan
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
04.07.04.01  Analgesics
Paracetamol
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Ibuprofen
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  MHRA Drug Safety Update (June 2015): High-dose ibuprofen (≥2400mg/day): small increase in cardiovascular risk
 
Naproxen tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Aspirin
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Diclofenac
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  MHRA Drug Safety Update (Dec 2007): NSAIDs and coxibs: balancing of cardiovascular and gastrointestinal risks
Link  MHRA Drug Safety Update (Jan 2015): Cox-2 selective inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs): Cardiovascular safety.
Link  MHRA Drug Safety Update (June 2013): Diclofenac: new contraindications and warnings
Link  MHRA Drug Safety Update (Oct 2012): Non-steroidal anti-inflammatory drugs (NSAIDs): cardiovascular risks
 
04.07.04.01  5HT1 agonists
Sumatriptan
View adult BNF View SPC online View childrens BNF
First Choice
Green
 
Zolmitriptan 2.5mg tablets
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Frovatriptan
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
04.07.04.01  Ergot alkaloids
04.07.04.01  Anti-emetics to top
Metoclopramide
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Used to help promote absorption of analgesics.
 
Link  MHRA Drug Safety Update Alert (Aug 2013): Metoclopramide: risk of neurological adverse effects
 
04.07.04.01  Other drugs for migrane
04.07.04.02  Prophylaxis of migraine
Pizotifen
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Metoprolol
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Propranolol
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Topiramate
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • MHRA Drug Safety Update (July 2022): Topiramate (Topamax): start of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities in children with prenatal exposure
 
 
Clonidine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Clonidine is not generally recommended for migraine prophylaxis; may aggravate depression/cause insomnia.
 
 
Eptinezumab (Vyepti®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 100mg/1ml concentrate for solution for infusion
    • Approved for the prevention of chronic migraine in adults in line with NICE only if
      • they have 4 or more migraine days a month
      • at least 3 preventative drug treatments have failed
 
Link  NICE TA871: Eptinezumab for preventing migraine
 
Erenumab (Aimovig®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 70mg/1ml and 140mg/1ml solution for injection (pre-filled pens)
    • Approved for the prevention of chronic migraine in adults in line with NICE only if
      • they have 4 or more migraine days a month
      • at least 3 preventative drug treatments have failed

 

 
Link  NICE TA682: Erenumab for preventing migraine in adults
 
Fremanezumab (Ajovy®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 225mg/1.5ml solution for injection (Pre-filled pens/syringes)
    • Approved for the prevention of chronic migraine in adults in line with NICE only if
      • they have 4 or more migraine days a month
      • at least 3 preventative drug treatments have failed


 
Link  NICE TA764: Fremanezumab for preventing migraine
 
Galcanezumab (Emgality®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
  • 120mg/1ml injection
    • Approved for the prevention of chronic migraine in adults in line with NICE only if
      • they have 4 or more migraine days a month
      • at least 3 preventative drug treatments have failed



 
Link  NICE TA659: Galcanezumab for preventing migraine
 
Rimegepant  (Vydura®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 75mg oral lyophilisates
  • Approved for preventing migraine in line with NICE
  • Approved for treating migraine in line with NICE 
 
Link  NICE TA906: Rimegepant for preventing migraine
Link  NICE TA919: Rimegepant for treating migraine
 
Botulinum Toxin Type A
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA260: Botulinum toxin type A for the prevention of headaches in adults with chronic migraine
 
Amitriptyline
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green
 
 
Imipramine
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green
 
 
Sodium valproate
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green
  • Note: sodium valproate 500mg & 1000mg MR granules (Episenta®) are also approved for use in those who have difficulty swallowing sodium valproate tablets. MR granules may be more convenient to use than large volumes of liquid formulations.

Black Triangle in Females

Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP)  Amber

For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:

MHRA Drug Safety Updates (valproate)

 
Link  Valproate medicines: Pregnancy Prevention Programme materials
 
04.07.04.03  Cluster headache
 note 

NTAG - Non-invasive transcutaneous vagus nerve stimulation (nVNS) for treatment of cluster headache and migraine

Lithium carbonate
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Amber
  • Lithium should be prescribed by brand name.
 
Link  Lithium Shared Care Guideline (Amber)
 
Lithium citrate
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Amber
  • Lithium should be prescribed by brand name.
 
Link  Lithium Shared Care Guideline (Amber)
 
04.08  Antiepileptics
04.08.01  Control of epilepsy to top
 note 

The MHRA recommend that patients on certain antiepileptic drugs remain on the same brand where possible. In order to help decide which anti-epileptics may or may not be switched the MHRA have classified anti-epileptics in to 3 categories.

Category 1 - the patient should be maintained on a specific manufacturer’s product (carbamazepine, phenobarbital and phenytoin)

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 (clobazam, clonazepam, eslicarbazepine acetate, lamotrigine, oxcarbazepine, perampanel, retigabine, rufinamide, sodium valproate, topiramate, and zonisamide).

Category 3 - usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors (acetazolamide, brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, stiripentol, and vigabatrin).

Acetazolamide
(Category 3)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Brivaracetam
(Category 3)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Approved for use as adjunctive therapy in patients with severe/intractable partial onset seizures e.g. a sezuire frequency of 1 per week following failure of first-line adjunctive therapy. Response must be assessed within 3-6 months before transferring prescribing to primary or stopping treatment, as appropriate.
 
 
Controlled Drug Cannabidiol (Epidyolex®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • 100mg/1mL oral solution
    • Approved for use in combination with clobazam for treating seizuires associated with Dravet syndrome in people aged 2 years and older
    • Approved for use in combination with clobazam for treating seizures associated with Lennox-Gastaut syndrome
    • Approved as an add-on treatment option for seizures caused by tuberous sclerosis complex in people aged 2 years and over - in line with NICE TA873.
 
Link  NICE TA614: Cannabidiol with clobazam for treating seizures associated with Dravet syndrome
Link  NICE TA615: Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome
Link  NICE TA873: Cannabidiol for treating seizures caused by tuberous sclerosis complex
 
Carbamazepine
(Category 1)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Carbamazepine 200mg and 400mg MR tablets (Tegretol® retard) are available on consultant request for those in whom conventional carbamazepine has been shown to be unsuitable Green Traffic Light
 
 
Carbamazepine Suppositories
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Clobazam
(Category 2)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Clonazepam
(Catergory 2)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Clonazepam 500microgram in 5ml sugar-free oral solution is also approved unlicensedunlicensed
 
 
Eslicarbazepine
(Category 2)
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Formulary
Green plus
  • Approved for use by specialists only in those patients for whom intolerance of carbamazepine is a major concern and when use of this agent is more cost effective than alternatives available.
 
 
Ethosuximide
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
FenfluramineBlack Triangle (Fintepla®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England

Oral solution: 2.2mg/mL

 
Link  NICE TA808: Fenfluramine for treating seizures associated with Dravet syndrome
 
Gabapentin
(Category 3)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Note: gabapentin 250mg in 5ml is also approved unlicensedunlicensed.
 
Link  MHRA Drug Safety Alert (Oct 2017): Gabapentin (Neurontin): risk of severe respiratory depression
 
Lacosamide
(Category 3)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Only approved on advice from consultant neurologists, in patients that are refractory to treatment with other drugs.
 
 
Lamotrigine
(Category 2)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Levetiracetam
(Category 3)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Oxcarbazepine
(Category 2)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Perampanel
(Category 2)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • NETAG approved for partial (focal) seizure epilepsy only when other treatment  options recommended by NICE have been tried or fully considered.
 
Link  NTAG - Perampanel (Fycompa®) for epilepsy
 
Controlled Drug Phenobarbital
(Category 1)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Phenobarbital INJECTION
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Phenytoin
(Category 1)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Note: phenytoin 30mg in 5ml suspension (base) – 90mg (15ml) is equivalent to one 100mg phenytoin sodium capsule 250mg in 5ml injection (sodium salt).
 
 
Piracetam
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Pregabalin
(Category 3)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Approved for specialist advice in the management of treatment resistant epilepsy. 
  • Also approved as a second line agent for General Anxiety Disorder. Although treatment can be given 2-3 times daily, it is more cost effective to give as a twice daily dose. 
 
Link  MHRA Drug Safety Update (Apr 2022): Pregabalin (Lyrica): findings of safety study on risks during pregnancy
Link  MHRA Drug Safety Update (Feb 2021): Pregabalin (Lyrica): reports of severe respiratory depression
 
Primidone 
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Rufinamide
(Category 2)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for limited use as a second or third-line treatment in patients with Lennox-Gastaut syndrome and related encephalopathies.
  • Should only be used on the advice of paediatric neurologists and other neurologists specialising in the treatment of epilepsy.
 
 
Sodium Valproate
(Category 2)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Note: sodium valproate 500mg & 1000mg MR granules (Episenta®) - for possible use in those who have difficulty swallowing sodium valproate tablets. May be more convenient to use than large volumes of liquid formulations.
  • Valproate▼ must no longer be prescribed to women and girls of childbearing potential unless there is no alternative and they are on the Pregnancy Prevention Programme (PPP) Amber

▼ BLACK TRIANGLE IN FEMALES

Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP)

For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:

MHRA Drug Safety Updates (valproate)

 
Link  Valproate medicines: Pregnancy Prevention Programme materials
Link  Local Shared Care guideline in TEWV to support Valproate Pregnancy Prevention Programme
 
Sodium Valproate▼ Injection
View adult BNF View SPC online View childrens BNF
Formulary
Red

Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP)

For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:

MHRA Drug Safety Updates (valproate)

 
 
Stiripentol
(Category 3)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • For use as adjunctive therapy of refractory generalised tonicclonic seizures in children with severe myoclonic epilepsy in infancy.
 
 
Tiagabine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Topiramate
(Category 2)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Vigabatrin
(Category 3)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
 
Link  North of Tyne, Gateshead and North Cumbria - Vigabatrin Shared Care Guideline
 
Zonisamide
(Category 2)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus

 

    • For use only in patients that are refractory to treatment with other drugs on the recommendation of a specialist

 

    • Use in children is unlicensedunlicensed.

 

 
 
04.08.01  Partial seizures with or without secondary generalisation
04.08.01  Generalised seizures
04.08.01  Carbamazepine and Oxcarbazepine
04.08.01  Ethosuximide
04.08.01  Gabapentin and pregabalin to top
04.08.01  Lacosamide
04.08.01  Lamotrigine
04.08.01  Levetiracetam
04.08.01  Perampanel
04.08.01  Phenobarbital and other barbiturates to top
04.08.01  Phenytoin
04.08.01  Retigaine
04.08.01  Rufinamide
04.08.01  Rufinamide
04.08.01  Tiagabine to top
04.08.01  Topiramate
04.08.01  Valproate
04.08.01  Vigabatrin
04.08.01  Zonisamide
04.08.01  Benzodiazepines to top
04.08.01  Other Drugs
Cenobamate (Ontozry®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Green plus

  • 12.5mg, 25mg, 50mg, 100mg, 150mg and 200mg tablets

  • Approved for treating focal onset seizure in epilepsy in line with NICE

    • Patients will be stabilised by the epilepsy specialist prior to transfer to the GP for continuation. This will usually be after 3 months of treatment.



 
Link  NICE TA753: Cenobamate for treating focal onset seizures in epilepsy
 
04.08.02  Drugs used in status epilepticus
Diazepam
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Controlled Drug Midazolam
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Buccolam® 5mg in 1ml alcohol-free buccal solution, and Buccolam® 2.5mg, 5mg, 7.5mg and 10mg prefilled oral syringes are approved as first choice for status epilepticus in children aged 3 months to 18 years. 
  • Epistatus® 10mg in 1ml oromucosal solution pre-filled oral syringes is approved for use in the treatment of epileptic seizures in infants under 3 months and adults over 18 years of age. This use is off-label Injection solutions (section 15.1.4) can also be given buccally



 

 
Link  MHRA Letters sent to healthcare professionals (January 2018): Buccolam (midazolam) – risk of inhalation/ingestion of tip cap of prefilled plastic syringes.
 
Phenobarbital Sodium
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Clonazepam
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus

  • For initiation by neurologists only.

 
 
Lorazepam
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus

  • For initiation by neurologists only.

  • Lorazepam  2mg/ml suspension & 4mg/ml suspension are also approved but are unlicensedunlicensed.

  • Buccal administration of lorazepam suspensions are only approved for use in paediatrics in children with status epilepticus in whom buccal midazolam, rectal paraldehyde or rectal diazepam are ineffective.Red Traffic Light

 
 
Phenytoin sodium 250mg in 5ml injection
View adult BNF View SPC online View childrens BNF
Alternatives
Red

 

    • For initiation by neurologists only.

 

 
 
Paraldehyde rectal liquid
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red

 

    • For initiation by neurologists only.

 

 
 
04.08.03  Febrile convulsions
Paracetamol
View adult BNF View SPC online View childrens BNF
Formulary
Green

Paracetamol suppositories



  • unlicensedunlicensed preparations include 15mg, 30mg, 60mg, 120mg, 240mg, and 500mg. These are used in NUTH.

  • Licensed preparations include 60mg, 125mg, 250mg, and 500mg suppositories are available in primary care.

 
 
04.09  Drugs used in parkinsonism and related disorders
04.09.01  Dopaminergic drugs used in Parkinsons disease to top
Cabergoline
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Foslevidopa/foscarbidopa  (Produodopa®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • foslevidopa 240mg/foscarbidopa 12mg in 1ml solution for infusion
  • Approved for the treatment advanced Parkinson’s with motor symptoms in adults in line with NICE and NHSE Specialised Commissioning Policy
 
Link  NICE TA934: Foslevodopa–foscarbidopa for treating advanced Parkinson’s with motor symptoms
 
Levidopa/carbidopa Intestinal Gel (Duodopa®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England
  • levidopa 20mg/carbidopa 5mg intestinal gel
  • Approved for the treatment of Parkinson's disease
 
 
Pergolide
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Pramipexole (restless legs)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Safinamide
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • 50mg and 100mg tablets
  • Approved for use in Parkinson's Disease patients on levodopa who are having motor fluctuations affecting their quality of life as an alternative to rasagiline.
 
 
04.09.01  Dopamine receptor agonists
Apomorphine
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • 5mg/1ml (20ml) solution for infusion for infusion pumps & 10mg/1ml (3ml) solution for injection cartridges (Dacepton®) - NEW PATIENTS
  • 30mg/3ml solution for injection (APO-go®) - Patients commenced on treatment prior to July 2022 can continue on APO-go® (including 50mg/10ml solution for infusion pre-filled syringes for infusion pumps)
  • Apomorphine 10mg lozenges are also approved (RVI) unlicensedUnlicensed
 
Link  County Durham Shared Care Guidelines: Apomorphine
Link  MHRA Drug Safety Update (April 2016): Apomorphine with domperidone: minimising risk of cardiac side effects
Link  North of Tyne, Gateshead and North Cumbria - Apomorphine - Shared Care Guidance
Link  South Tyneside & Sunderland APC Shared Care Guideline - Apomorphine injection or infusion for Parkinson’s disease
Link  Tees Valley Shared Care Guidelines: Apomorphine
 
Bromocriptine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Pramipexole
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Approved for second line use in Parkinson's disease. 
 
 
Ropinirole
View adult BNF View SPC online View childrens BNF
Formulary
  • Ropinirole once daily formulation is only approved for use in Parkinson’s disease patients with proven compliance. Green plus
  • Approved for first line use in patients with restless legs syndrome. Green

 

 
 
Rotigotine
(Parkinsons)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • For use on the advice of specialists in the treatment of Parkinson's disease. Mainly for use in patients who have difficulty with swallowing.
  • Approved for second line use in patients with restless legs syndrome.
 
 
04.09.01  Levodopa
Co-Beneldopa
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Co-Careldopa
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Co-Careldopa and Entacapone
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
04.09.01  Monoamine-oxidase-B inhibitors
Rasagiline
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Selegiline Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 5mg and 10mg tablets
 
 
04.09.01  Catachol-O-methyltransferase inhibitors
Entacapone
View adult BNF View SPC online View childrens BNF
First Choice
Green plus
 
Opicapone
View adult BNF View SPC online View childrens BNF
First Choice
Green plus
 
Tolcapone
View adult BNF View SPC online View childrens BNF
Alternatives
Red
 
 
04.09.01  Amantadine to top
Amantadine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • For use on the advice of neurologists.
 
 
04.09.01  Mild to moderate dementia in Parkinsons disease
04.09.02  Antimuscarinic drugs used in parkinsonism
Orphenadrine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus

 

    • 5mg/5ml Liquid

 

 
 
Procyclidine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Trihexyphenidyl
(Benzhexol)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
04.09.03  Drugs used in essential tremor, chorea, tics, and related disorders
Botulinum Toxin Type A (Botox®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Botox also approved for use in paediatric patients with severe bladder over- activity and neuropathic bladder who have not responded to other treatment.
  • Prescribe by brand name.

 

 
 
Botulinum Toxin Type A (Dysport®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Prescribe by brand name.

 
 
Botulinum Toxin Type A (Vistabel®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • Restricted to use in private patients receiving aesthetic treatment.
  • Prescribe by brand name.

 

 
 
Botulinum Toxin Type A injection (Xeomin ® )
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  •  50, 100 & 200 unit powder for solution for injection
    • Approved for the treatment of chronic sialorrhoea in line with NICE
    • Similar potency to Botox®, and may be less expensive (depending on price agreements/ contracts), but not licensed for the full range of indications.
    • Prescribe by brand name.



 

 
Link  NICE TA605: Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea
 
Botulinum Toxin Type B (NeuroBloc®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

  • Prescribe by brand name

 
 
Riluzole
View adult BNF View SPC online View childrens BNF
Formulary
Amber
High Cost Medicine
  • 50mg tablets; 50mg orodispersible tablets (Emylif); 5mg/1ml oral suspension
  • Approved for motor neurone disease in line with NICE. 
  • Note: riluzole orodispersible film and oral suspension approved only when other preparations (including crushing tablets) are not suitable.

 
Link  NENC Shared Care Protocol - riluzole for patients in adult services
Link  NICE TA20: Motor neurone disease - riluzole
Link  Shared Care Guideline
 
Tetrabenazine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • For use on the advice of neurologists. 
 
 
Memantine
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Approved for use as last line drug after other alternatives have been considered, in the treatment of congenital and acquired nystagmus.
 
 
04.09.03  Torsion dystonias and other involuntary movements
04.09.04  Restless leg syndrome to top
04.10  Drugs used in substance dependence
04.10  Alcohol dependence
04.10  Cigarette smoking
04.10  Opioid dependence
04.10.01  Alcohol dependence to top
Acamprosate
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • COUNTY DURHAM Red acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
 
 
Chlordiazepoxide
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • COUNTY DURHAM Red acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
 
 
Disulfiram
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • COUNTY DURHAM Red acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
 
 
Nalmefene
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Only approved for use in accordance with NICE guidance.
  • COUNTY DURHAM Red acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
 
Link  NICE TA325: Nalmefene for reducing alcohol consumption in people with alcohol dependence
 
Naltrexone
(alcohol dependence)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
04.10.02  Nicotine dependence
Bupropion Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
  • RAG status as per local commissioning arrangements
  • MHRA Drug Safety Update (Nov 2020): Bupropion (Zyban): risk of serotonin syndrome with use with other serotonergic drugs
  • Resistant depression Red
 
 
Nicotine
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • The following nicotine replacement treatments are approved:
    • Nicotine gum -  2mg & 4mg sugar-free chewing gum (Nicorette® is the gum of choice).
    • Nicotine 16 hour patch - 10mg, 15mg, and 25mg/16 hour patches (Nicorette® Invisi). 
    • Nicotine 24 hour patch - 7mg & 14mg, and 21mg /24 hour patches (Nicotinell® is the patch of choice as potential savings to be made).
    • Nicotine lozenges - 2mg and 4mg lozenges (Niquitin® is the lozenge of choice), 1.5mg and 4mg mini lozenges (NiQuitin® Minis Lozenges).
    • Nicotine 2mg sublingual tablets.
    • Nicotine inhalator -  15mg cartridges for use in inhalator.
    • Nicotine oromucosal spray - Nicorette® Quickmist 1mg per dose.

  • North Cumbria - Smoking Cessation is commissioned separately through community pharmacies and should not be prescribed on FP10's
  • Newcastle/Gateshead - Local Authority smoking cessation programme should be used. NRT should not routinely be prescribed on FP10

 

 
 
Varenicline
View adult BNF View SPC online View childrens BNF
Formulary
  • Only approved for use in accordance with NICE guidance. 
  • RAG status as per local commissioning arrangements.
 
Link  NICE TA123: Varenicline
 
04.10.03  Opioid dependence
Controlled Drug Buprenorphine 400 microgram, 2mg, and 4mg sublingual tablets
View adult BNF View SPC online View childrens BNF
Formulary
Red

  • Only approved for use in accordance with NICE guidance. 

  • In the treatment of substance misuse the 400microgram strength should be prescribed as Subutex® to avoid a product licensed for pain relief being supplied

 
 
Controlled Drug Buprenorphine and Naloxone (Suboxone®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Lofexidine (BritLofex®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Green plus South Tyneside and Sunderland only 
 
 
Controlled Drug Methadone
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Methadone 5mg in 5ml oral solution and 5mg in 5ml sugar free solution are both approved for the management of opioid dependence in line with NICE.
  • Red CD&TV and ST&S
 
 
Naltrexone 50 mg tablets (Nalorex®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for the management of opioid dependence in detoxified formerly opioid-dependent people in line with NICE.
  • Also approved NoTGhdNC for use in reducing agitation and/ or selfinjurious behaviour in patients with learning disabilities or autism (unlicensedunlicensed indication). Treatment must be initiated by an appropriate hospital specialist.
 
Link  NICE TA115: Drug misuse - naltrexone
 
04.10.03  Opioid substitution therapy
Controlled Drug Buprenorphine (Buvidal®)
View adult BNF View SPC online View SMC online View childrens BNF
Alternatives
Red
  • 8mg/0.16ml 16mg/0.32ml, 24mg/0.48ml, 32mg/0.64ml, 64mg/0.18ml, 96mg/0.27ml, 128mg/0.36ml 160mg/0.45ml prolonged-release solution for injection (pre-filled syringes).
    • Approved for the treatment of opioid dependance  in adults and adolescents aged 16 years and over, by substance misuse service providers, in line with NTAG and RMOC guidance.


 

 
Link  NTAG - Buprenorphine prolonged release injection for opioid dependence
 
04.10.03  Adjunctive therapy and symptomatic treatment
04.10.03  Opioid-receptor antagonists to top
04.11  Drugs for dementia
 note 

Only specialists in the care of patients with dementia (psychogeriatricians and certain neurologists) should initiate treatment.

 

Donepezil
View adult BNF View SPC online View childrens BNF
First Choice
Green plus
  • Only approved for use in accordance with NICE guidance. 
 
Galantamine
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance. 
  • The oral solution is only approved for limited short-term use in the management of hospital patients who are unable to swallow tablets/ capsules. It is not for use in patients whose dementia is so severe that they can no longer swallow tablets.
 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
 
Memantine
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
 
Rivastigmine
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Only approved for use in accordance with NICE guidance. 
  • Rivastigmine patches are approved for patients unable to tolerate treatment with oral rivastigmine due to nausea and vomiting, and for patients requiring treatment with an acetylcholinesterase inhibitor who are unable to take oral medication e.g. due to swallowing difficulties or ‘nil by mouth’ prior to surgery.
 
Link  NICE TA217: Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease
 
04.12  Miscellaneous
Dehydrated alcohol 100% BP for Injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for intrathecal neurolysis treatment of intractable pain due to cancer in terminally ill patients
 
 
Inotersen  (Tegsedi®)
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Formulary
Red
High Cost Medicine
NHS England

  • Approved as an option for treating stage 1 and stage 2 polyneuropathy in adults with hereditary transthyretin amyloidosis in line with NICE

 
Link   NICE Highly specialised technologies 9: Inotersen for treating hereditary transthyretin amyloidosis
 
Patisiran (Onpattro®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England

  • 10mg vial 

  • Approved for the treatment of hereditary transthyretin amyloidosis in adults with stage 1 and stage 2 polyneuopathy in line with NICE

 
Link  NICE Highly specialised technologies 10: Patisiran for treating hereditary transthyretin amyloidosis
 
Phenol 5% in Glycerol Injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for intrathecal neurolysis treatment of intractable pain due to cancer in terminally ill patients
 
 
VutrisiranBlack Triangle (Amvuttra®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England
  • Approved as an option for treating hereditary transthyretin-related amyloidosis in adults with stage 1 or stage 2 polyneuropathy - in line with NICE TA868.
  • Summer 2023 - Only one centre in London commissioned to provide this drug for patients in England.
 
Link  NICE TA868: Vutrisiran for treating hereditary transthyretin-related amyloidosis
 
 ....
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
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary