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Pan Mersey
Area Prescribing Committee
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 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:

Review date: June 2020

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

Chapter Links...
 Details...
04.02.01  Expand sub section  Antipsychotic Drugs
 note 

Oral Antipsychotics (except clozapine)
The RAG status of oral antipsychotics is supported in principle as Amber Initiated. However this recommendation is subject to assurance from the respective Mental Health Trusts that robust systems are in place to support patients and GPs, and that patients can be discussed and/or seen in a timely manner if the GP considers it to be necessary.
See Mersey Care and North West Boroughs Healthcare referral information at links below.

04.02.01  Expand sub section  First-Generation Antipsychotic Drugs
04.02.01  Expand sub section  Second-Generation Antipsychotic Drugs
 note 

Pan Mersey APC (2018). ATYPICAL ANTIPSYCHOTICS, prescribing support information

Amisulpride
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Tablets 50 mg, 100 mg, 200 mg, 400 mg
Solution 100 mg/mL

Amber Patient Retained Paediatrics (in children aged 15 years and above)

 

 
   
Aripiprazole
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Tablets 5 mg, 10 mg, 15 mg, 30 mg
Orodispersible tablets10 mg, 15 mg
Oral solution 1 mg/1 mL (very expensive - use orodispersible tablets where possible)

Amber Patient Retained Paediatrics

 
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
Link  NICE TA292: Bipolar disorder (adolescents) - aripiprazole
   
Lurasidone
View adult BNF View SPC online
Formulary
Amber Initiated

Tablets 18.5mg, 37mg, 74mg

Lurasidone should only be prescribed as an alternative treatment option when existing antipsychotic treatments are unsuitable for adult patients with schizophrenia who have experienced or are at risk of excessive weight gain and metabolic adverse events.

No BNFc entry – seek specialist advice

 

 
   
Olanzapine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Tablets 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg
Orodispersible tablets 5 mg, 10 mg, 15 mg, 20 mg
NB oral lyophylisate form is not cost effective.

Amber Patient Retained Paediatrics (in children aged 12 years and above)

 
   
Quetiapine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Immediate release formulations
Tablets 25 mg, 100 mg, 150 mg, 200 mg, 300 mg

Modified release formulations <!> Expensive
M/R Tablets 50 mg, 150 mg 200 mg, 300 mg, 400 mg
Use of QUETIAPINE M/R tablets should be reserved for individual patients identified as having a defined clinical need for the modified release formulation. Justification of the decision to continue prescribing the QUETIAPINE M/R formulation should be documented in the clinical notes and made clear in any discharge/appointment letters to the GP e.g. compliance, over-sedation or other adverse effect issues

Oral liquid 20mg/mL Amber Patient Retained Paediatrics (in children aged 12 years and above)

 

 
Link  QUETIAPINE Immediate Release I/R Tablets (All Brands), Pan Mersey Area Prescribing Committee Policy Statement
   
Risperidone
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Tablets 500 micrograms, 1 mg, 2 mg, 3 mg, 4 mg, 6 mg
Liquid 1 mg/mL
Orodispersible tablets 500 micrograms, 1 mg, 2 mg, 3 mg, 4mg

 

Amber Patient Retained Paediatrics

 
   
Cariprazine
View adult BNF View SPC online
Formulary
Grey

Capsules 1.5mg, 3mg, 4.5mg and 6mg

 
Link  Pan Mersey Area Prescribing Committee Prescribing Policy Statement: CARIPRAZINE capsules (Reagila®▼) for Schizophrenia in Adults
   
Clozapine (Denzapine®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Tablets 25 mg, 100 mg
Suspension 50 mg/mL
 
   
 ....
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
SMC
Scottish Medicines Consortium
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

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

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