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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.02.01  Expand sub section  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  Expand sub section  First Generation Antipsychotic Drugs
Chlorpromazine
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Formulary
Green plus
 
 
Haloperidol
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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
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Formulary
Green plus
 
 
Zuclopenthixol
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Formulary
Green plus
 
 
Flupentixol
(Flupenthixol)
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Alternatives
Green plus
 
 
Levomepromazine
(Methotrimeprazine)
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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  Expand sub section  Second Generation Antipsychotic Drugs
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®)
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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 


 

 
 
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
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.  

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