Search
4. Central Nervous System

MHRA Alert (Feb 2015):  Drugs and driving: blood concentration limits set for certain drugs

Please refer to NICE guidelines NICE TA77

CSM Advice:

  1. Benzodiazepines are indicated for short term relief (2-4 weeks only) of anxiety that is severe, disabling or causing the patient unacceptable distress, occurring alone or in association with insomnia or short term psychotic illness.
  2. The use of benzodiazepines to treat short term anxiety is inappropriate. 
  3. Benzodiazepines should be used to treat insomnia only when it is severe, disabling or causing the patient extreme distress. 
Melatonin (Circadin)
BNF | BNFC | SPC

2mg M/R tablets

For the treatment of insomnia – (particularly sleep maintenance insomnia in the elderly). Delayed sleep phase syndrome and other circadian dysrhythmias; a second line drug variety of parasomnias requiring drug treatment.

Transfer of prescribing of all other melatonin products is not supported – prescribing responsibility should remain with the consultant – i.e. RED drug

Melatonin (Circadin) - TEWV
BNF | BNFC | SPC

MR Tabs 2mg

In clinical practice within Tees, melatonin is used "off-label" for chronic sleep disturbance resulting in severe stress for the patient and/or family, in children, young people and adults with the following conditions:

  • Neurological or behavioural disorders including:
    • Attention Deficit Hyperactivity Disorder
    • Autistic Spectrum Disorders
    • Emotional dysregulation
    • Chronic sleep-onset insomnia
  • Neurodevelopment disabilities (e.g. delayed brain maturation, sensory dysfunction - especially visual, and dysfunction of sleep centres)
  • Chronic fatigue syndrome/myalgic encephalomyelitis with associated sleep difficulties (as recommended in NICE clinical guideline 53).

As long as the patient is being prescribed Circadin® transfer of prescribing to primary care is appropriate.

For TEWV patients, please see agreed shared care guideline

Transfer of prescribing of all other melatonin products is not supported – prescribing responsibility should remain with the consultant – i.e. RED drug

Temazepam
BNF | BNFC | SPC

Tablets 10mg, 20mg

Benzodiazepines are indicated for the short term relief (2-4 weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short term psychosomatic, organic or psychotic illness. Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress.

Zolpidem
BNF | BNFC | SPC

5mg and 10mg tablets

NICE TA77

Zolpidem is not licensed for long term use.

Zopiclone
BNF | BNFC | SPC

Tablets 3.75mg, 7.5mg

Zopiclone is not licensed for long term use.

NICE TA77

Chlordiazepoxide
BNF | BNFC | SPC

Chlordiazepoxide is a red drug when used in alcohol detoxification

Lorazepam
BNF | BNFC | SPC

Tabs 1mg

 

Refer to NICE guidance for schizophrenia CG 178

See also: NICE NG11 - Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges

The choice of antipsychotic should take into account the relative side-effect profile and the views of the user.

Benperidol
BNF | BNFC | SPC

250microgram tablet,

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Chlorpromazine
BNF | BNFC | SPC

Tabs 25mg, 50mg, 100mg

Oral solution 25mg/5ml, 100mg/5ml

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Haloperidol
BNF | BNFC | SPC

Capsule 500microgram,

Tablets 1.5mg, 5mg, 

NICE NG10

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Pimozide
BNF | BNFC | SPC

Schizophrenia

Promazine
BNF | BNFC | SPC

25mg, 50mg Tablets

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Sulpiride
BNF | BNFC | SPC

Tabs 200mg, 400mg 

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Trifluoperazine
BNF | BNFC | SPC

Tabs 1mg, 5mg

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Zuclopentixol
BNF | BNFC | SPC

Tabs 2mg, 10mg, 25mg

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Amisulpride
BNF | BNFC | SPC

Tabs 50mg, 100mg, 200mg.

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Aripiprazole
BNF | BNFC | SPC

5mg, 10mg, 15mg, Tablets.

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

NICE TA213, TA292

TEWV Safe Transfer of Prescribing Guidance

Clozapine
BNF | BNFC | SPC

Schizophrenia

Lurasidone
BNF | BNFC | SPC

NTAG Rejected: Lurasidone for schizophrenia in adults 9/4/15 - Rejected as further data showing advantages over aripiprazole is required before recommending its use

Olanzapine
BNF | BNFC | SPC

Tabs 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg

Orodispersible Tabs 5mg, 10mg, 20mg

Orodispersible tablets should only be prescribed for patients who are unable to swallow solid dose forms.

Do not prescribe as Lyophilisates.

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

 

Quetiapine
BNF | BNFC | SPC

25mg, 100mg, 150mg, 200mg, 300mg tablets

M/R Tablets 50mg, 150mg, 200mg, 300mg, 400mg

M/R tablets should only be used where standard tablets are unsuitable.

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

 

Risperidone
BNF | BNFC | SPC

Tabs 500microgram, 1mg, 2mg, 3mg, 4mg, 6mg

1mg/ml oral solution sugar free.

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Refer to NICE Guideline Bipolar Disorder CG185

 Antipsychotics drugs can be useful in acute episodes of mania and hypomania.

Asenapine
BNF | BNFC | SPC

Moderate to severe manic episodes associated with bipolar disorder

Lithium Carbonate
BNF | BNFC | SPC

400mg  (Camcolit), Tabs 200mg, 400mg (Priadel)

MR Tabs 450mg (Liskonum)

Must be prescribed as brand

Initiated by specialist only.

Minimum of one months supply will be given to patients before transferring to primary care.

TEWV Shared Care Guidelines and Safe Transfer of Prescribing Guidance

Lithium Citrate
BNF | BNFC | SPC

Oral Solution 509mg/5ml (Li-Liquid), 520mg/5ml (Priadel)

Must be prescribed as brand

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Shared Care Guidelines and Safe Transfer of Prescribing Guidance

Valproic Acid
BNF | BNFC | SPC

Tabs E/C 250mg, 500mg (as semi sodium valproate)

150mg, 300mg gastro resistant capsules.

Initiation by specialist; Prescribing follows psychosis care pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

NICE CG28: Depression in children and young people: Identification and management in primary, community and secondary care

Amitriptyline
BNF | BNFC | SPC

10mg, 25mg, 50mg Tablets

 

 

Clomipramine
BNF | BNFC | SPC

Caps 10mg, 25mg, 50mg

Dosulepin
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

NICE CG90: Depression in Adults states 'do not switch to, or start dosulepin because evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose'.

PrescQIPP bulletin 126: Dosulepin

Lofepramine
BNF | BNFC | SPC

70mg Tablets

 

Moclobemide
BNF | BNFC | SPC

Tabs 150mg, 300mg.

Initiation by specialist; Prescribing follows Depression Care Pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Phenelzine
BNF | BNFC | SPC

15mg Tablets

Initiation by specialist; Prescribing follows Depression Care Pathway; Baseline monitoring completed; Stabilised on treatment; Minimum of one month's supply on transfer; Annual review of medication by specialist services whilst actively involved in providing treatment

TEWV Safe Transfer of Prescribing Guidance

Citalopram
BNF | BNFC | SPC

Tabs 10mg, 20mg, 40mg

Oral Drops 40mg/ml

Escitalopram
BNF | BNFC | SPC

5mg, 10mg, 20mg Tablets

When prescribed in TEWV, initiation is by specialist; Prescribing follows Depression Care Pathway

Fluoxetine
BNF | BNFC | SPC

Caps 20mg

Liquid 20mg/5ml

Sertraline
BNF | BNFC | SPC

Tabs 50mg, 100mg

Agomelatine
BNF | BNFC | SPC

Depression

Not Approved: NICE TA231

 

Duloxetine
BNF | BNFC | SPC

Capsules 30mg, 60mg

Initiated by a specialist.

Minimum of one months supply will be given to patients before transferring to primary care.

 

Mirtazapine
BNF | BNFC | SPC

Tabs 15mg, 30mg, 45mg

Orodispersible Tabs 15mg, 30mg, 45mg 

Orodispersible tablets should only be prescribed for patients who are unable to swallow solid dose forms

Venlafaxine
BNF | BNFC | SPC

Tabs 37.5mg, 75mg 

Standard release tablets should be used where possible. If MR preparation is required please use tablets.

MR 37.5mg, 75mg, 120mg, TABLETS

Doses over 225mg daily should be specialist initiation only.

Vortioxetine
BNF | BNFC | SPC

5mg, 10mg, 20mg tablets.

Approved in line with NICE TA367

TEWV Depression Pathway Medication Algorithm for secondary care

NICE TA98

Atomoxetine
BNF | BNFC | SPC

Caps 10mg, 18mg, 25mg, 40mg, 60mg, 80mg 100mg hard capsules

Initiated by specialist only - shared care protocol available.

TEWV Shared Care and Safe Transfer of Prescribing Guidance

 

Dexamfetamine
BNF | BNFC | SPC

5mg Tablets

Initiated by specialist only

This drug is Amber (to be initiated in secondary care), but there is no Shared Care protocol to follow

TEWV Safe Transfer of Prescribing Guidance

Guanfacine
BNF | BNFC | SPC

ADHD

Lisdexamfetamine
BNF | BNFC | SPC

20mg, 30mg, 40mg, 50mg, 60mg and 70mg capsules

ADHD

TEWV Lisdexamfetamine Shared Care Guidelines

Mazindol
BNF | BNFC | SPC

Narcolepsy

Methylphenidate
BNF | BNFC | SPC

Tabs 5mg, 10mg, 20mg

MR Tabs 18mg, 27mg, 36mg, 54mg.

MR Caps 5mg, 10mg, 20mg, 30mg, 40mg.

Initiated by specialist only - shared care protocol available

MR products must be prescribed by brand.

TEWV Shared Care and Safe Transfer of Prescribing Guidance

Modafinil
BNF | BNFC | SPC

Initiated by specialist only

Neurology Shared Care Guidelines

All other indications are Red

Orlistat
BNF | BNFC | SPC

120mg capsules

Ensure patient is weighed and monitored as per NICE Guidance

NICE clinical guideline 43

 

Naltrexone - Bupropion
BNF | BNFC | SPC

Not Approved for managing overweight and obesity: NICE TA494

Cinnarizine
BNF | BNFC | SPC

Tablets 15mg

Cyclizine
BNF | BNFC | SPC

Tablets 50mg

Nabilone
BNF | BNFC | SPC

Nausea and vomiting caused by cytotoxic chemotherapy

Granisetron
BNF | BNFC | SPC

Nausea and vomiting induced by cytotoxic chemotherapy or radiotherapy; Postoperative nausea and vomiting

Palonosetron
BNF | BNFC | SPC

Chemo-induced nausea and vertigo

Hyoscine Butylbromide
BNF | BNFC | SPC

10mg tablets

Aprepitant
BNF | BNFC | SPC

Chemo-induced nausea and vertigo

Netupitant / palonosetron
BNF | BNFC | SPC

Chemotherapy-induced nausea and vomiting

Betahistine
BNF | BNFC | SPC

8mg, 16mg Tablets

 

Droperidol
BNF | BNFC | SPC

Post-op nausea and vertigo

Prochlorperazine
BNF | BNFC | SPC

5mg tablets

NICE CG173: Neuropathic pain

Self-Care Analgesia
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

Includes Migraleve preparations

Short courses of analgesics for acute common ailments can be purchased by the patient under self-care with community pharmacist support.

Continue to prescribe for children and when required for chronic conditions although patients should be reminded that these medications are also available to purchase.

Prescribing short courses of pain relief for acute conditions costs the NHS more than the equivalent products purchased over the counter (prescription fees, GP consultation time etc.)

PrescQIPP DROP List

Co-Proxamol
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

Co-proxamol is markedly more toxic in overdose than paracetamol and was withdrawn from the market in 2005 doe to safety concerns and marketing authorisation cancelled at the end of 2007

PrescQIPP bulletin 42: Reviewing existing co-proxamol patients

Nefopam
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

Prescribing of nefopam is not supported by Hartlepool & Stockton-on-Tees and South Tees CCGs.

Nefopam should not be initiated for acute or chronic pain, or continued post discharge following secondary care acute initiation. Only continue nefopam in line with recommendations of the specialist pain service. Review existing patients - assess benefits versus adverse effects and consider stopping; withdraw slowly over 1-2 weeks following chronic use.

Adverse effects are common, nefopam is toxic in overdose and has abuse potential through its psychostimulant-like effects.  Nefopam is very expensive.

Hartlepool & Stockton-on-Tees and South Tees CCGs position statement on nefopam

Paracetamol
BNF | BNFC | SPC

500mg tablets.

120mg/5ml oral solution sugar free

250mg/5ml oral suspension sugar free

 

Paracetamol Injection
BNF | BNFC | SPC
Paracetamol / tramadol
BNF | BNFC | SPC

Tramacet

Tees Do Not Prescribe/Grey List

This combined preparation has both drugs at lower than suggested doses and is also more expensive than the separate components.

PrescQIPP bulletin 62: Switching Tramacet® to paracetamol alone or paracetamol and codeine

PrescQIPP DROP List

Ziconotide
BNF | BNFC | SPC

Intrathecal Analgesia

Aspirin / Codeine (Co-codaprin)
BNF | BNFC | SPC

Tees Do Not Prescribe/Grey List

This preparation does not allow for effective dose titration and the advantages of using a compound formulation have not been substantiated. There is no instance where this product is appropriate to use from a safety or efficacy point of view, over existing treatments.

Codeine
BNF | BNFC | SPC

Tablets 15mg, 30mg, 60mg

MHRA Drug Safety Update Links

 

Dihydrocodeine Tartrate
BNF | BNFC | SPC

30mg Tablets

60mg, 90mg, 120mg MR tablets

Fentanyl Immediate Release Preparations
BNF | BNFC | SPC

Sublingual tablets, buccal tablets, lozenges, nasal sprays

Tees Do Not Prescribe/Grey List

NHS England (November 2017) advises that primary care prescribers should not initiate immediate-release fentanyl preparations for new patients. NHS England also supports the deprescribing of immediate-release fentanyl preparations. More cost-effective preparations are available.

NHS England recommendations for immediate-release fentanyl do not apply to patients undergoing palliative care treatment arranged with a suitable specialist

PrescQIPP briefing B32: Immediate release fentanyl

 

Fentanyl citrate immediate release sublingual tablet (Abstral)
BNF | BNFC | SPC

100, 200, 300, 400, 600, 800 microgram tablets to replace the use of Actiq lonzenge.

For breakthrough / rescue pain relief in palliative care patients (patients with life-limiting illness requiring specialist palliative care team member review) who have:

1. Intolerance of morphine / oxycodone

2. Renal impairment which necessitates strong opioid choice other than morphine /oxycodone

3. Dysphagia

Fentanyl Patches
BNF | BNFC | SPC

Transdermal patches 12microgram/hour, 25microgram/hour, 50microgram/hour, 75microgram/hour, 100microgram/hour.

Prescribe by brand

Only use in stable chronic pain where oral medication is not tolerated or suitable.

MHRA Drug Safety Update

MHRA Drug Safety Update: Serious and Fatal Overdose of Fentanyl Patches

 

Morphine Sulphate
BNF | BNFC | SPC

Tablets 10mg, 20mg, 50mg (Sevredol)

MR capsules 10mg, 30mg, 60mg, 100mg (Zomorph)

Injection 10mg/ml, 15mg/ml, 20mg/ml, 30mg/ml

Prescribe by brand

Oxycodone
BNF | BNFC | SPC

5mg, 10mg, 20mg, Capsules

5mg/5ml Liquid

5mg, 10mg, 15mg, 20mg, 30mg, 40mg, 60mg, 80mg, 120mg MR Tablets

Prescribe by brand

Oxycodone / naloxone
BNF | BNFC | SPC

Targinact

Tees Do Not Prescribe/Grey List

Randomised controlled trials have only compared with standard-release oxycodone, NOT with other strong opioids such as morphine, with regular laxatives. There is no data showing that combined oxycodone and naloxone reduce the need for laxatives in the long-term.

PrescQIPP briefing 56: Oxycodone/ naloxone prolonged relase (Targinact®) tablets

Tapentadol
BNF | BNFC | SPC

Accepted by South Tees D&T as a treatment option for pain clinic when other treatments (e.g. morphine) have failed in chronic pain patients.

Rejected by North Tees and Hartlepool D&T 10/05/2013

Tramadol
BNF | BNFC | SPC

50mg Capsules

Buprenorphine Patches (Butec)
BNF | BNFC | SPC

5mcg, 10mcg, 15mcg, 20mcg/hr transdermal patch

Lidocaine Plaster
BNF | BNFC | SPC

Initiation by pain team only.

NICE CG173 on neuropathic pain does not recommend the use of lidocaine patches as a treatment option due to limited clinical evidence supporting its use

Rizatriptan
BNF | BNFC | SPC

10mg Orodispersible tablets or standard tablets

DO NOT PRESCRIBE AS LYOPHILISATES

Sumatriptan
BNF | BNFC | SPC

50mg and 100mg Tablets   

Also licensed for treatment of cluster headaches. If ineffective an alternative 5HT1-receptor agonist may be tried

Refer to NICE guidance CG 137. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care.

Brivaracetam
BNF | BNFC | SPC

Approved for use as 3rd or 4th line treatment

Carbamazepine
BNF | BNFC | SPC

Tablets 100mg, 200mg, 400mg

MR Tablets 200mg, 400mg

Liquid 100mg/5ml

Use in bipolar should be on specialist advice only

Category 1 in epilepsy treatment - ensure patient is maintained on specific manufacturers product. 

Clobazam
BNF | BNFC | SPC

Tablets 10mg

Only prescribable on NHS for epilepsy. Must be endorsed SLS.

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Clonazepam
BNF | BNFC | SPC

Initiated by specialist only

Tablets 500microgram, 2mg.

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Eslicarbazepine
BNF | BNFC | SPC

Inititated by specialist only.

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Gabapentin
BNF | BNFC | SPC

Capsules 100mg, 300mg, 400mg

Also licensed for neuropathic pain.

Category 3 in epilepsy treatment - it is usually unnecessary to ensure the patient is maintained on a specific manufacturers product unless there are specific concerns.

Lacosamide
BNF | BNFC | SPC

50mg, 100mg, 150mg, 200mg Tablets

Initiated by specialist only

IV dose is same as oral.

Category 3 in epilepsy treatment - it is usually unnecessary to ensure the patient is maintained on a specific manufacturers product unless there are specific concerns.

Lamotrigine
BNF | BNFC | SPC

Tablets 25mg, 50mg, 100mg, 200mg

Dispersible Tablets 2mg, 5mg, 25mg, 100mg

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Levetiracetam
BNF | BNFC | SPC

Tablets 250mg, 500mg, 750mg and 1g

Sugar Free solution 100mg/ml.

Category 3 in epilepsy treatment - it is usually unnecessary to ensure the patient is maintained on a specific manufacturers product unless there are specific concerns.

Oxcarbazepine
BNF | BNFC | SPC

150mg & 300mg tablets.

Inititated by specialist only.

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Perampanel
BNF | BNFC | SPC

Initiated by specialist only as per NICE guidance.

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Phenobarbital
BNF | BNFC | SPC

Tablets 15mg, 30mg.

 Category 1 in epilepsy treatment - ensure patient is maintained on specific manufacturers product.

 

Phenytoin (Sodium Salt)
BNF | BNFC | SPC

Capsules 25mg, 50mg, 100mg, 300mg,

Suspension 30mg/5ml, Suspension contains phenytoin base - care need when changing to or from capsules

Category 1 in epilepsy treatment - ensure patient is maintained on specific manufacturers product.

Pregabalin
BNF | BNFC | SPC

Capsules 25mg 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg

Also licensed for neuropathic pain.

Category 3 in epilepsy treatment - it is usually unnecessary to ensure the patient is maintained on a specific manufacturers product unless there are specific concerns.

Primidone
BNF | BNFC | SPC

50mg, 250mg Tablets

For epilepsies initiated by specialist only

Category 1 in epilepsy treatment - ensure patient is maintained on specific manufacturers product.

Retigabine
BNF | BNFC | SPC

Initiated by specialist only as per NICE guidance.

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Rufinamide
BNF | BNFC | SPC

Lennox-Gastaut syndrome

Sodium Valproate
BNF | BNFC | SPC

Tablets e/c 200mg, 500mg,

Tablets MR 200mg, 300mg, 500mg,

Oral Solution 200mg/5ml,

Tablets (crushable) 100mg

Not licensed for Prophylaxis of migraine

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Stiripentol (STHFT)
BNF | BNFC | SPC
Tiagabine
BNF | BNFC | SPC

For epilepsies initiated by specialist only

Topiramate
BNF | BNFC | SPC

Tablets 25mg, 50mg, 100mg.

Capsules (Sprinkle) 15mg, 25mg.

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Vigabatrin
BNF | BNFC | SPC

Tablets 500mg

Powder (Sugar free) 500mg/Sachet

Initiated by specialist only

Category 3 in epilepsy treatment - it is usually unnecessary to ensure the patient is maintained on a specific manufacturers product unless there are specific concerns.

Zonisamide
BNF | BNFC | SPC

25mg, 50mg, 100mg Capsules

Initiated by specialist only.

Category 2 in epilepsy treatment the need for continued supply of a particular manufacturers produce should be based on clinical judgment and consultation with the patient taking into account factors such as seizure frequency and treatment history.

Diazepam
BNF | BNFC | SPC

Rectal Solution 2mg/ml, 4mg/ml

Midazolam Buccal
BNF | BNFC | SPC

Oromucosal Solution 5mg/ml

Pre-filled syringes 0.5ml, 1ml, 1.5ml, 2ml (Buccolam)

 

NICE CG186:  Multiple sclerosis: management of multiple sclerosis in primary and secondary care

Apomorphine
BNF | BNFC | SPC

Parkinson's Disease

Neurology Shared Care Guideline

Cabergoline
BNF | BNFC | SPC

Tablets 1mg, 2mg.

Initiated by specialist only

Shared care

Neurology Shared Care Guidelines

Co-beneldopa (Madopar)
BNF | BNFC | SPC

Capsules 62.5mg, 125mg, 250mg

Dispersible Tablets 62.5mg, 125mg

MR Capsules 125mg

Co-careldopa (Sinemet)
BNF | BNFC | SPC

Tablets 62.5mg, 110mg, 125mg, 275mg

MR Tablets 125mg, 250mg

Entacapone
BNF | BNFC | SPC

Tablets 200mg.

Initiated by specialist only.

Opicapone
BNF | BNFC | SPC

For treatment of Parkinson’s disease  – second or third line - used in patients who have tried and failed on entacapone. Green hospital initiated and first supply must be from specialist

Pergolide
BNF | BNFC | SPC

50mcg, 250mcg, 1mg Tablets

Neurology Shared Care Guidelines

Pramipexole
BNF | BNFC | SPC

Tablets (as Base) 88microgram, 180microgram, 350microgram, 700microgram

Initiated by specialist only Care should be taken when prescribing as confusion can occur beween strength of salt and drug

 

Rasagiline
BNF | BNFC | SPC

1mg tablets

Initiated by specialist only

Ropinirole
BNF | BNFC | SPC

Tablets 250microgram, 500microgram, 1mg, 2mg, 5mg

Tablets MR 2mg, 4mg, 8mg

Rotigotine
BNF | BNFC | SPC

Patches 1mg/24hours, 2mg/24hours, 3mg/24hours, 4mg/24hours6mg/24hours, 8mg/24hours

Safinamide
BNF | BNFC | SPC

For treatment of Parkinson’s disease as an adjunct to levodopa alone or in combination with other antiparkinsonian drugs. 

First supply from secondary care.

Selegiline Hydrochloride
BNF | BNFC | SPC

Tablets 5mg, 10mg

Initiated by specialist only.

Tolcapone
BNF | BNFC | SPC

Initiated by specialist only

Only in patients who have failed on entacapone

Neurology Shared Care Guidelines

 

Bromocriptine
BNF | BNFC | SPC

Parkinson's Disease

Neurology Shared Care Guideline

Acamprosate
BNF | BNFC | SPC

Tablets 333mg

To be prescribed by Substance Misuse Service only

Disulfiram
BNF | BNFC | SPC

Tablets 200mg

To be prescribed by Substance Misuse Service only

Nalmefene
BNF | BNFC | SPC

Tablets 18mg

Approved: NICE TA325

To be prescribed by Substance Misuse Service only in line with NICE Guidance

Buprenorphine
BNF | BNFC | SPC

Sublingual tablets 400micrograms, 2mg, 8mg

To be prescribed by Substance Misuse Service only

Approved: NICE TA114

Lofexidine
BNF | BNFC | SPC

Management of symptoms of opioid withdrawal

To be prescribed by Substance Misuse Service only

Methadone Hydrochloride
BNF | BNFC | SPC

Oral Solution 1mg/ml

Sugar Free Oral Solution 1mg/ml

Oral Concentrate 10mg/ml, 20mg/ml

To be prescribed by Substance Misuse Service only

Approved: NICE TA114

Naltrexone
BNF | BNFC | SPC

To be prescribed by Substance Misuse Service only

Approved: NICE TA115

Buprenorphine / naloxone
BNF | BNFC | SPC

Suboxone

Tablets - 2mg/500mcg, 8mg/2mg

To be prescribed by Substance Misuse Service only

Donepezil (TEWV)
BNF | BNFC | SPC

Tablets 5mg, 10mg

Orodispersible Tablets 5mg, 10mg

Only use orodispersible if patient has genuine need.

Initiated by specialist only

NICE TA217

TEWV Safe Transfer of Prescribing Guidance

Galantamine (TEWV)
BNF | BNFC | SPC

Tablets 8mg, 12mg

MR Capsules 8mg, 16mg, 24mg

MR capsules only to be used when a once a day dose is essential or patient has tried standard release galantamine and is intolerant.

Initiated by specialist only.

NICE TA217

TEWV Safe Transfer of Prescribing Guidance

Rivastigmine (TEWV)
BNF | BNFC | SPC

Capsules 1.5mg, 3mg, 4.5mg

Oral solution 2mg/ml

Patches 4.6mg / 24hours; 9.5mg/24hours

Patches and oral solution should only be used when other formulations are inappropriate

Initiated by specialist only

NICE TA217

TEWV Safe Transfer of Prescribing Guidance

Memantine (TEWV)
BNF | BNFC | SPC

Tablets 10mg 20mg

Oral Solution 10mg/ml

Oral solution should only be used when other formulations are inappropriate

Initiated by specialist only.

NICE TA217

TEWV Safe Transfer of Prescribing Guidance