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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.

Paediatrics - all drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

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04.02.03  Expand sub section  Drugs used for mania and hypomania
 note 

All persons with a recent-onset suspected mania / hypomania or severe depression should be seen urgently by a specialist in mental health. This is to ensure precise and early diagnosis and initiation of therapy as appropriate to their needs.

Acute episodes of rapid-cycling bipolar disorder and treatment refractory bipolar depression should normally be managed in specialist mental health services.

When managing depressive symptoms of bipolar disorder those prescribed an antidepressant should also be prescribed an antimanic drug under the guidance of a specialist in mental health.

Women of child-bearing age must be given accurate information and counselling about contraception, conception, pregnancy and breastfeeding.

Toolkit on the risks of valproate medicines in female patients

Always consider non-adherence when treatment is ineffective.

Treatment should continue for at least 2 years from the last manic episode and up to 5 years if there are risk factors for relapse.

Asenapine
View adult BNF View SPC online
Formulary
Amber Initiated

Sublingual tablets 5mg, 10mg

No BNFc entry – seek specialist advice

 
   
Lamotrigine
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Formulary
Amber Initiated

Tablets, 25 mg; 50 mg; 100 mg; 200 mg
Dispersible tablets, 2 mg; 5 mg; 25 mg; 100 mg

No BNFc entry – seek specialist advice

 
   
04.02.03  Expand sub section  Benzodiazepines
04.02.03  Expand sub section  Antipsychotic drugs
04.02.03  Expand sub section  Carbamazepine
 note  Anticonvulsants are potentially teratogenic and so all women of childbearing age need to be counselled of the risks. In general the risk of major congenital malformations related to anticonvulsant monotherapy is around 4%.
Carbamazepine
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Formulary
Amber Initiated

Tablets 100 mg, 200 mg, 400mg
Tablets M/R 200 mg, 400 mg
Liquid 100 mg/5 mL

 

 
   
04.02.03  Expand sub section  Valproic acid to top
 note 

Toolkit on the risks of valproate medicines in female patients 

Valproic Acid Semisodium (Depakote®)
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Formulary
Amber Initiated

Tablets 250 mg, 500 mg

 

Amber Patient Retained Paediatrics

 

 
   
04.02.03  Expand sub section  Lithium
 note 

Lithium has been the subject of a National Patient Safety Agency Patient Safety Alert

Lithium Carbonate (Camcolit®)
(Prescribe by brand)
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Formulary
Purple

M/R tablets 400 mg
 

Purple Paediatrics (in children above 12 years)

 
   
Lithium Carbonate (Liskonum®)
(Prescribe by brand)
View adult BNF View SPC online View childrens BNF
Formulary
Purple

M/R tablets 450 mg

Purple Paediatrics (in children above 12 years)

 
   
Lithium Carbonate (Priadel®)
(Prescribe by brand)
View adult BNF View SPC online View childrens BNF
Formulary
Purple

MR tablets 200 mg, 400 mg

Purple Paediatrics (in children above 12 years)

 
   
Lithium Citrate (Li-Liquid®)
(Prescribe by brand)
View adult BNF View SPC online View childrens BNF
Formulary
Purple

liquid 509 mg/5 mL, 1.018 g/5 mL

Purple Paediatrics (in children above 12 years)

 
   
Lithium Citrate (Priadel®)
(Prescribe by brand)
View adult BNF View SPC online View childrens BNF
Formulary
Purple

liquid SF 520 mg/5 mL

Purple Paediatrics (in children above 12 years)

 
   
 ....
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

Amber Recommended  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose and the patient’s condition 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 and the patient’s condition 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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