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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...
04.04  Expand sub section  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
 note 

Attention Deficit Hyperactivity Disorder (ADHD)

A diagnosis should only be made by, and treatment started only under the guidance of,  a specialist psychiatrist or other specialist with training and expertise in ADHD.

Methylphenidate and dexamfetamine do not have a UK product licence for use in adults with ADHD.

Atomoxetine is licensed for adults with ADHD when the drug has been started in childhood. Informed consent for off-label use should be obtained and documented.

Baseline physical health checks should be carried out including height (children and adolescents), weight, blood pressure, pulse, and where appropriate an ECG and blood tests.

The above checks should be repeated and the efficacy and tolerability of drug treatment reviewed as per BNF, SPC or Shared Care documents as appropriate. 

For people taking methylphenidate, dexamfetamine and lisdexamfetamine a risk assessment should be made for substance misuse and drug diversion.

Young people continuing treatment into adulthood should be reassessed to establish the need for continuing treatment.

Atomoxetine
(Children and adults diagnosed in childhood)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Capsules 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80mg, 100mg
Oral liquid 4mg/mL
 
Purple Knowsley CCG, Liverpool CCG, Wirral CCG - Adults and Children
 
Purple  Halton CCG, South Sefton CCG and Southport & Formby CCG - for the treatment of ADHD in Adults only 

 
Link  Pan Mersey Shared Care Framework for Atomoxetine
Link  NHS South Sefton and NHS Southport and Formby CCGs
   
Dexamfetamine
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets 5 mg, 10mg, 20mg

Oral solution 5mg/5mL
For the treatment of ADHD. In addition, for the treatment of narcolepsy in adults
 
Purple Knowsley CCG, Liverpool CCG, Wirral CCG - Adults and Children
 
Purple  Halton CCG, South Sefton CCG and Southport & Formby CCG - for the treatment of ADHD in Adults only 

 
Controlled Drug Schedule 2
Link  Pan Mersey Shared Care Framework for Dexamfetamine
Link  NHS South Sefton and NHS Southport and Formby CCGs
   
Guanfacine
View adult BNF View SPC online View childrens BNF
Formulary
Red

Prolonged-release tablets; 1mg, 2mg, 3mg, 4mg
 
Purple Knowsley CCG, Liverpool CCG, Wirral CCG - Adults and Children
 
Purple  Halton CCG, South Sefton CCG and Southport & Formby CCG - for the treatment of ADHD in Adults only 

 
Link  Pan Mersey Shared Care Framework for Guanfacine
   
Lisdexamfetamine
View adult BNF View SPC online View childrens BNF
Formulary
Red

Capsule 20mg, 30 mg, 40mg, 50 mg, 60mg, 70 mg

There can be variation in the licensing of different medicines containing the same drug.
 


Purple Knowsley CCG, Liverpool CCG, Wirral CCG - Adults and Children
 
Purple  Halton CCG, South Sefton CCG and Southport & Formby CCG - for the treatment of ADHD in Adults only 

 
Controlled Drug Schedule 2
Link  Pan Mersey Shared Care Framework for Lisdexamfetamine
Link  NHS South Sefton and NHS Southport and Formby CCGs
   
Methylphenidate
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets 5 mg, 10 mg, 20 mg
Modified-release tablets 18 mg, 27 mg, 36 mg, 54mg.

Modified-release capsules 5mg, 10mg, 20mg, 30mg, 40mg, 50mg, 60mg.

IMPORTANT: Different modified release preparations have different release profiles and different dosages. Therefore the brand of modified release methylphenidate should be maintained and stated on the prescription.


Purple Knowsley CCG, Liverpool CCG, Wirral CCG - Adults and Children
 
Purple  Halton CCG, South Sefton CCG and Southport & Formby CCG - for the treatment of ADHD in Adults only 

 
Controlled Drug Schedule 2
Link  Pan Mersey Shared Care Framework for Methylphenidate
Link  NHS South Sefton and NHS Southport and Formby CCGs
   
Modafinil
View adult BNF View SPC online
Formulary
Amber Retained

Tablets 100 mg, 200 mg

Modafinil is indicated for excessive sleepiness associated with narcolepsy with or without cataplexy only.

Red Paediatrics

 

 
   
04.04  Expand sub section  Cocaine
 ....
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 patientís 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 patientís 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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