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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...
04.07.02  Expand sub section  Opioid analgesics
Codeine
(1st line weak opiate)
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First Choice

Codeine phosphate
Tablets: 15 mg, 30 mg, 60 mg
Syrup: 25 mg/5 mL

Injection 60mg/ml - hospital only

 
Controlled Drug Morphine Sulphate
(1st line strong opiate)
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First Choice IR tablets: 10 mg, 20 mg, 50 mg
MR capsules for twice daily administration (Zomorph®): 10 mg, 30 mg, 60 mg, 100 mg, 200 mg
MR tablets: 5 mg, 15 mg
MR suspension sachets: 20 mg, 30 mg, 60 mg, 100 mg, 200 mg
N.B. the MR suspension sachets are only for use when other formulations are unsuitable
Oral solution: 10 mg/5 mL, 20 mg/1 mL
Injection: 10 mg/1 mL, 15 mg/1 mL, 20 mg/1 mL, 30 mg/1 mL
Suppositories: 10 mg, 15 mg, 20 mg, 30 mg
 
Dihydrocodeine
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Alternatives

Tablets: 30mg

 

Not recommended for regular use. Codeine is the first line weak opioid.

 
   
Dihydrocodeine
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Alternatives
Green +

SR Tablets: 60mg, 90mg, 120mg
SR formulation only to be used on advice of pain specialists

Not recommended for regular use. Codeine is the first line weak opioid.

 
   
Controlled Drug Tramadol
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Alternatives
Green +

MR: 50mg, 100mg, 150mg, 200mg, 300mg, 400mg
MR formulation only to be used on advice of pain specialists

 
   
Controlled Drug Tramadol
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Alternatives Capsules: 50 mg
Soluble Tablets: 50 mg

 
   
Controlled Drug Buprenorphine
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Alternatives

Transdermal patches: 5mcg, 10mcg, 15mcg, 20mcg/hour over 7 days*
Transdermal patches: Transtec® 35mcg, 52.5mcg, 70mcg/hour over 96 hours

*Sevodyne preferred brand in primary care

 

 

Red Sublingual tablets: 200micrograms

* For treatment of post-operative pain only*

 
   
Controlled Drug Fentanyl
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Alternatives Transdermal patches: 12, 25, 50, 75 and 100 micrograms/hour 
   
Controlled Drug Oxycodone
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Alternatives IR capsules: 5 mg, 10 mg, 20 mg
Liquid: 5 mg/5 mL, 10 mg/1 mL
Injection: 10 mg/1 mL, 20 mg/2 mL, 50 mg/1 mL
MR tablets: 5 mg, 10 mg, 20 mg, 40 mg, 80 mg
 
   
Controlled Drug Alfentanil
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Alternatives
Green +

Injection: 500 micrograms/1 mL, 5 mg/1 mL

Specialist initiation only - consult pain team or palliative care before use.

 
   
Controlled Drug Diamorphine
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Alternatives
Green +

Injection: 5 mg, 10 mg, 30 mg, 100 mg, 500 mg
N.B. 10mg strength also used in maternity

Specialist initiation only - consult pain team or palliative care before use.

 
   
Controlled Drug Fentanyl Lozenges
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Alternatives
Green +

Lozenges*: 200mcg, 400mcg

*Existing chronic or palliative care patients only

 
   
Controlled Drug Fentanyl Nasal Spray (PecFent®)
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Alternatives
Green +

Nasal spray (PecFent): 100 micrograms/metered spray, 400 micrograms/metered spray

N.B. For short term use in palliative care only.

Specialist initiation only - consult pain team or palliative care before use.

 
   
Controlled Drug Fentanyl sublingual tablets (Abstral®)
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Alternatives
Green +

Sublingual tablets (Abstral): 100 micrograms, 200 micrograms, 300 micrograms, 400 micrograms, 600 micrograms, 800 micrograms

N.B. For short term use in palliative care only.

Specialist initiation only - consult pain team or palliative care before use.

 
   
Controlled Drug Hydromorphone
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Alternatives
Green +
Ampoules*: 10mg/ml

*For palliative care use only 
   
Controlled Drug Hydromorphone
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Alternatives

IR capsules 1.3 mg, 2.6 mg
SR capsules : 2 mg, 4 mg, 8 mg, 16 mg, 24 mg

Specialist initiation only - consult pain team or palliative care before use.

 
   
Controlled Drug Methadone
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Alternatives
Green +

Tablets: 5 mg
Linctus: 2 mg/5 mL
Oral Concentrate: 10mg/mL
Injection: 10 mg/1 mL

 

Specialist initiation only - consult pain team or palliative care before use as an analgesic.

(Red when used for addiction)

 
   
Controlled Drug Pethidine
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Alternatives
Red

Injection: 50 mg/1 mL, 100 mg/2 mL, 50 mg/5 mL, 100 mg/10 mL

 

Only for use by midwives or in palliative care.

 
   
Controlled Drug Tapentadol (Palexia®)
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Alternatives
Green +

Palexia® MR Tablets: 50 mg, 100 mg, 150 mg, 200 mg, 250 mg
Use only after trial with other strong opiates

Specialist initiation only - consult pain team or palliative care before use.

 
   
Ketamine
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Unlicensed Drug Unlicensed
Red

Injection: 10 mg/1 mL, 50 mg/1 mL, 100 mg/1 mL
Oral solution: 50mg/5mL

 
   
 ....
 Non Formulary Items
Controlled Drug  Dextromoramide

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Non Formulary
 
Controlled Drug  Dipipanone  (Diconal®)

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Non Formulary
 
Meptazinol  (Meptid®)

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Non Formulary
 
Controlled Drug  Morphine and cyclizine  (Cyclimorph®)

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Non Formulary
 
Controlled Drug  Papaveretum

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Non Formulary
 
Controlled Drug  Pentazocine

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Non Formulary
 
Controlled Drug  Pethidine Hydrochloride and promethazine  (Pamergan® P100)

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Non Formulary
 
Sufentanil  (Zalviso®)

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Non Formulary
 
Controlled Drug  Targinact (Oxycodone/Naloxone)  (Targinact®)

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Non Formulary
 
Controlled Drug  Targinact (Oxycodone/Naloxone)  (Targinact®)

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Non Formulary
 
Controlled Drug  Tramadol Hydrochloride and paracetamol  (Tramacet®)

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Non Formulary
 
Controlled Drug  Tramadol oral drops

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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
click to search medicines.org.uk
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. In some cases there may be a further restriction for use outlined - these will be defined in each case.  

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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