Sunderland Joint Formulary Formulary


	Sunderland Joint Formulary NHS Sunderland Clinical Commissioning Group South Tyneside and 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...

04.04

CNS stimulants and other drugs used for attention deficit hyperactivity disorder

Methylphenidate

First Choice

Tablets: 5mg, 10mg

MR Tablets: 18mg, 27mg, 36mg, 54mg (Xaggitin XL® or Concerta XL®)

MR Capsules: 5mg, 10mg, 20mg, 30mg, 40mg (Medikinet XL®)

MR Capsules: 10mg, 20mg, 30mg (Equasym XL®)

NOTE

- Concerta XL is also approved for the treatment of narcolepsy in patients

Dexamfetamine

Second Choice

Tablets: 5mg

ADHD in children and adults : AMBER - see shared care guideline.

Narcolepsy: Doses up to 30mg GREEN +, doses over 30mg RED

Lisdexamfetamine (Elvanse^®)

Third Choice

Capsules: 20mg, 30mg, 40mg, 50mg, 60mg, 70mg (Elvanse®)
- For 3rd line use after an inadequate response to methylphenidate.
- For specialist initiation and only transferred to GPs after at least 6 month stable symptoms control.

Atomoxetine

Formulary

Capsules: 10mg, 18mg, 25mg, 40mg, 60mg, 80mg

Guanfacine (Intuniv^®)

Formulary

Prolonged release tablets: 1mg, 2mg, 3mg, 4mg

Modafinil

Formulary

Tablets: 100 mg
- Only approved for limited use in the treatment of patients with narcolepsy

Pitolisant

Formulary

Tablets: 20mg
- approved for use in patients with narcolepsy who experience psychomotor side effects with modafinil and dexamfetamine.

NICE NG87: Attention deficit hyperactivity disorder (ADHD)

NICE TA98: Attention deficit hyperactivity disorder (ADHD) - methylphenidate, atomoxetine and dexamfetamine

04.04

Cocaine

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	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.
	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.
	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. In some cases there may be a further restriction for use outlined - these will be defined in each case.
	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.