Formulary Chapter 4: Central nervous system - Full Chapter
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Chapter Links... |
MHRA Drug Safety Alert (Feb 2015): Drugs and driving: blood concentration limits set for certain drugs |
NENC Palliative and End of Life Care Symptom Control Guidelines |
NICE NG62: Cerebral palsy in under 25s: assessment and management |
TEWV - Medicines Optimisation – Interactive Guide |
TEWV Guidelines |
TEWV Safe Transfer of Prescribing Guidance |
Details... |
04.10 |
Drugs used in substance dependence |
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04.10 |
Alcohol dependence |
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04.10 |
Cigarette smoking |
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04.10 |
Opioid dependence |
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04.10.01 |
Alcohol dependence |
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Acamprosate
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Formulary
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- COUNTY DURHAM acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
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Chlordiazepoxide
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Formulary
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- COUNTY DURHAM acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
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Disulfiram
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Formulary
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- COUNTY DURHAM acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
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Nalmefene
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Formulary
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- Only approved for use in accordance with NICE guidance.
- COUNTY DURHAM acamprosate, chlordioazepoxide, disulfiram & nalmefene prescribing should be retained within the commissioned service within County Durham.
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NICE TA325: Nalmefene for reducing alcohol consumption in people with alcohol dependence
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Naltrexone (alcohol dependence)
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Formulary
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04.10.02 |
Nicotine dependence |
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Bupropion Hydrochloride
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Formulary
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- 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
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Nicotine
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Formulary
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- 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
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Varenicline
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Formulary
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- Only approved for use in accordance with NICE guidance.
- RAG status as per local commissioning arrangements.
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NICE TA123: Varenicline
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04.10.03 |
Opioid dependence |
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Buprenorphine 400 microgram, 2mg, and 4mg sublingual tablets
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Formulary
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- 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
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Buprenorphine and Naloxone (Suboxone®)
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Formulary
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Lofexidine (BritLofex®)
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Formulary
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- South Tyneside and Sunderland only
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Methadone
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Formulary
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- 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.
- CD&TV and ST&S
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Naltrexone 50 mg tablets (Nalorex®)
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Formulary
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- 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 (unlicensed indication). Treatment must be initiated by an appropriate hospital specialist.
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NICE TA115: Drug misuse - naltrexone
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04.10.03 |
Opioid substitution therapy |
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Buprenorphine (Buvidal®)
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Alternatives
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- 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.
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NTAG - Buprenorphine prolonged release injection for opioid dependence
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04.10.03 |
Adjunctive therapy and symptomatic treatment |
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04.10.03 |
Opioid-receptor antagonists |
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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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. |
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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. |
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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. |
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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. |
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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. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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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. |
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