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NHS Sunderland Clinical Commissioning Group
City Hospitals Sunderland NHS Foundation Trust
 
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 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:

As psychiatric services are provided by Northumberland, Tyne and Wear NHS Foundation Trust (NTW) the drugs available for Sections 4.1, 4.2, 4.3 and 4.4 are those listed in the Formulary used by NTW which is the North of Tyne Formulary

 Details...
04.03.04  Expand sub section  Other antidepressant drugs
 note 

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


Venlafaxine
(N.B. RAG status is GREEN+ for doses of 300mg or more)
View adult BNF View SPC online
Formulary

Tablets: 37.5 mg, 75 mg
Solution: 75mg/5ml*
MR tablets: 75 mg, 150 mg
- 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 preparations 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.
(preferred brand of Venlafaxine XL in primary care is Vencarm XL)
*Hospital use only

 
Link  High dose venlafaxine information leaflet
   
Mirtazapine
View adult BNF View SPC online
Formulary Tablets: 15mg, 30mg, 45mg
Orodispersible tablets: 15mg, 30mg, 45mg
- Orodispersible tablets should only be prescribed for use when other formulations are unsuitable 
   
Reboxetine
View adult BNF View SPC online
Formulary Tablets: 4mg
- not licensed for use in the elderly
 
   
Duloxetine
View adult BNF View SPC online
Formulary Capsules: 30mg, 60mg
- For use on advice of psychiatrists as a 3rd 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.  
   
Agomelatine
View adult BNF View SPC online
Formulary
Green +
Tablets: 25mg
- 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  Information leaflet for primary care prescribers
   
 ....
 Non Formulary Items
Tryptophan

View adult BNF View SPC online
Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use or use by a specialist within specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the appropriate hospital clinician or specialist. These drugs should only be prescribed under the direct supervision of that clinician or specialist and are not suitable for shared care arrangements. The drug should be supplied via the hospital or specialist centre for the duration of treatment.   

Amber

These are specialist drugs which must be initiated by secondary care specialist prescribers, but with the potential to transfer prescribing to primary care within written and agreed shared care protocols and according to the agreed process for transfer of care. For these drugs, in order to ensure patient safety, some aspects of care must remain with the specialist due to their complexity e.g. monitoring of disease or drug response. Other more routine aspects can be transferred to the GP e.g. monitoring of adverse effects and supply of the medicine. The specific responsibilities of the specialist and GP are defined in the shared care agreement for each drug. Shared care agreements are still under development for some amber drugs. Until these are available, it would be expected that any shared care request from secondary care to a GP would be accompanied by written information which defines prescribing and monitoring responsibilities. The hospital specialist should also provide the GP with enough information and support to allow the safe transfer and ongoing management of prescribing into primary care.   

Green +

Drugs which should usually be initiated in secondary care, or by a specialist clinician, but can be safely maintained in primary care with very little or no monitoring required. An information leaflet may be provided in order to facilitate ongoing prescribing in primary care.   

Green

These are defined as new and established drugs, which may be prescribed, initiated, changed or maintained on FP10 by the GP and, if appropriate, discontinued without recourse to secondary care. N.B. DRUGS NOT IDENTIFIED IN THE FORMULARY BY A RED, AMBER OR GREEN+ SYMBOL ARE CLASSIFIED AS GREEN.   

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