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 Formulary Chapter 4: Central nervous system - Full Chapter
04.01  Hypnotics and anxiolytics
04.01.01  Hypnotics
Melatonin
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Formulary
Amber
M/R tablets
unlicensedCapsules (unlicensed)
unlicensed Tablets (unlicensed)
unlicensed Oral liquid (unlicensed)


Green Traffic Light  applies when licensed product used in adult patients over 55

note The licensed M/R tablets can be crushed for administration in dysphagia or via enteral feeding tubes if necessary. This obviously means that they would no longer be 'modified release'. 
Link  GMMMG Recommendation: Melatonin for insomnia
   
04.01.01  Benzodiazepines
Controlled Drug Temazepam
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First Choice Tablets
Oral solution 
Nitrazepam
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Formulary Tablets
Oral suspension 
   
04.01.01  Zaleplon, Zolpidem and Zopiclone
Zopiclone
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First Choice Tablets 
Zolpidem
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Formulary Tablets 
   
04.01.01  Chloral and derivatives to top
Chloral Hydrate 500mg in 5mL
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Formulary  
   
04.01.01  Antihistamines
Promethazine Hydrochloride
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Formulary Tablets
Elixir
Injection 
   
04.01.02  Anxiolytics
04.01.02  Benzodiazepines
Diazepam
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First Choice Tablets
Oral solution
Injection
Rectal tubes 
Lorazepam
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Formulary Tablets
Injection 
   
Oxazepam
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Formulary  
   
04.01.02  Beta blockers
 note  Beta-blockers are indicated for patients with predominantly autonomic symptoms such as palpitations and tremor.
See section 2.4.
04.01.03  Barbiturates to top
04.02  Drugs used in psychoses and related disorders
04.02.01  Antipsychotic Drugs
04.02.01  First-Generation Antipsychotic Drugs
Chlorpromazine
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First Choice Tablets
Oral solution
Injection 
Haloperidol
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First Choice Tablets
Capsules
Oral liquid
Injection 
Sulpiride
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Second Choice Tablets
Oral solution 
   
Flupentixol
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Formulary Tablets 
   
Levomepromazine
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Formulary Tablets
Injection 
   
Pericyazine
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Formulary Tablets 
   
Perphenazine
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Formulary Tablets 
   
Pimozide
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Formulary Tablets 
   
Promazine Hydrochloride
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Formulary Tablets
Oral solution

note Only licensed for agitation 
   
Trifluoperazine
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Formulary Tablets
Oral solution 5mg/5mL
Syrup 1mg/5mL 
   
Zuclopenthixol
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Formulary Tablets 
   
Zuclopenthixol Acetate injection (Clopixol Acuphase®)
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Formulary  
   
04.02.01  Second-Generation Antipsychotic Drugs
Olanzapine
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First Choice
Amber
Tablets
Orodispersible tablets 
Quetiapine
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First Choice
Amber
Tablets
M/R tablets
 
Risperidone
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First Choice
Amber
Tablets
Orodispersible tablets
Liquid 
Amisulpride
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Formulary
Amber
Tablets
Oral solution

Red Traffic Light RED when prescribed for new patients with dementia or other unlicensed indications 
   
Aripiprazole
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Formulary
Amber
Tablets
Orodispersible tablets
Oral solution
Injection (IM)

Red Traffic Light RED when prescribed for new patients with dementia or other unlicensed indications  
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 to 17 years
Link  NICE TA292: Aripiprazole for manic episodes in adolescents with bipolar I disorder
   
Clozapine (Clozaril®)
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Restricted Drug Restricted
Red
Clozapine is only indicated for treatment resistant schizophrenia.
Prescribers, pharmacies and patients must be registered with the relevant supplier’s patient monitoring service. 
Link  MHRA Safety Update: Potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
   
Clozapine (Zaponex®)
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Restricted Drug Restricted
Red
Clozapine is only indicated for treatment resistant schizophrenia.
Prescribers, pharmacies and patients must be registered with the relevant supplier’s patient monitoring service. 
Link  MHRA Safety Update: Potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
   
04.02.02  Antipsychotic depot injections to top
 note  Depots should be initiated by specialist mental health services
Flupentixol Decanoate (Depixol®)
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First Choice
Amber
 
Fluphenazine Decanoate (Modecate®)
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First Choice
Amber
 
Haloperidol (Haldol Decanoate®)
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First Choice
Amber
 
Pipotiazine Palmitate (Piportil®)
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First Choice
Amber
 
Zuclopenthixol Decanoate (Clopixol®)
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First Choice
Amber
 
Aripiprazole  (Abilify Maintena®)
(Prolonged release injection)
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Restricted Drug Restricted
Amber
Vial
 
Link  GMMMG NTS Recommendation: Apripiprazole prolonged release injection for treatment of schizophrenia
Link  Shared Care Guideline for Aripiprazole Long-Acting Injection
   
Risperidone (Risperdal Consta®)
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Restricted Drug Restricted
Amber
 
Link  Shared Care Guideline for Risperidone Long-Acting Injection
   
04.02.03  Drugs used for mania and hypomania
 note  Anti-manic drugs should be initiated by specialist mental health services
Asenapine
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Formulary Sublingual tablets

Restricted Item Pennine Care: may be considered third line for inpatients who have failed to respond or failed to tolerate existing therapies. 
   
04.02.03  Benzodiazepines
 note  Benzodiazepines may be helpful in the initial stages of treatment for behavioural disturbance or agitation. See section 4.1.
04.02.03  Antipsychotic drugs
 note  Antipsychotic drugs are useful in acute episodes of mania and hypomania. See section 4.2.1.
Anti-manic drugs should be initiated by specialist mental health services.
04.02.03  Carbamazepine
Carbamazepine
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Formulary
Green 3
Tablets
M/R tablets
Liquid
Suppositories
 
   
04.02.03  Valproic acid to top
Valproic Acid (Depakote®)
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Formulary
Green 3
Tablets 
Link  MHRA Safety Alert: Valproate and abnormal pregnancy outcomes
   
04.02.03  Lithium
 note  Lithium should be prescribed by brand.
Care needed when swapping from liquid to tablets and vice versa.
Lithium Carbonate tablets (Camcolit® or Priadel®)
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Amber
 
   
Lithium Citrate liquid (Li-Liquid® or Priadel®)
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Formulary
Amber
 
   
04.03  Antidepressant drugs
04.03.01  Tricyclic and related antidepressant drugs
04.03.01  Tricyclic antidepressants
Amitriptyline
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First Choice Tablets
Oral solution 
Clomipramine
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First Choice Capsules
M/R tablets

Included as first choice in the treatment of OCD only 
Imipramine
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First Choice Tablets
Oral solution 
Nortriptyline
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First Choice Tablets 
Lofepramine
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Formulary Tablets
Oral suspension 
   
04.03.01  Related antidepressants to top
Trazodone
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First Choice Capsules
Tablets
Liquid 
Mianserin
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Formulary  
   
04.03.02  Monoamine-oxidase inhibitors
 note 

All MAOIs have the potential to induce hypertensive crisis if foods containing tyramine are eaten. Such interactions are less and milder with moclobemide.

MAOIs should only be initiated by or on the advice of Consultant Psychiatrist/ Specialist Mental Health Services.

Moclobemide
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First Choice
Green 3
 
Phenelzine
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Formulary  
   
Tranylcypromine
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Formulary  
   
04.03.03  Selective serotonin re-uptake inhibitors
Sertraline
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First Choice Tablets 
Citalopram
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Formulary Tablets
Oral drops 
Link  MHRA Safety Update: Citalopram Interaction with Cocaine
Link  MHRA Safety Update: QT prolongation
   
Fluoxetine
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Formulary Capsules
Liquid 
   
Fluvoxamine Maleate
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Formulary Tablets 
   
Paroxetine
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Formulary Tablets
Oral suspension 
   
Escitalopram
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Restricted Drug Restricted Tablets
Oral drops 
Link  MHRA Safety Update: QT prolongation
   
04.03.04  Other antidepressant drugs
Mirtazapine
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First Choice Tablets
Orodispersible tablets 
Venlafaxine
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First Choice Tablets
M/R tablets or capsules 
Duloxetine (Cymbalta®)
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Flupentixol
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Formulary  
   
Reboxetine
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Formulary  
   
Tryptophan
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Formulary  
   
Agomelatine
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Formulary
Red
Restricted Item Agomelatine may have a role for specialist initiation, but only in those patients with severe depression who have already failed on all classes of antidepressant therapies. 
   
04.04  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
Controlled Drug Methylphenidate
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First Choice
Amber
Tablets
M/R tablets or capsules

First choice brand for Pennine Care is Matoride XL.  
Atomoxetine
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Restricted Drug Restricted
Amber
Mental health services only 
Link  GMMMG Shared Care Protocol: Atomoxetine for the Treatment of ADHD in Children and Adolescents
   
Controlled Drug Dexamfetamine
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Formulary
Amber
 
Link  GMMMG Shared Care Protocol: Dexamfetamine for Childhood and Adolescent ADHD
   
Guanfacine (Intuniv®)
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Formulary
Amber
Prolonged-release tablets 
Link  GMMMG Recommendation: Guanfacine for the Treatment of ADHD in Children and Adolescents
Link  GMMMG Shared Care Protocol: Guanfacine for Childhood and Adolescent ADHD
   
Lisdexamfetamine (Elvanse®)
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Formulary
Amber
Capsules

Restricted Item Pennine Care: Use may be considered second or third line when treatment with methylphenidate m/r not successful and patient has swallowing difficulties (as atomoxetine caps cannot be opened) and where drug diversion is not a risk.  
Link  GMMMG Shared Care Protocol: Lisdexamfetamine for Childhood and Adolescent ADHD
   
Modafinil
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Formulary
Amber
Tablets

AMBER for sleepiness associated with narcolepsy

 
Link  GMMMG Recommendation: chronic shift-work sleep disorder
Link  NICE Evidence Summary: Modafinil for fatigue in multiple sclerosis
   
04.05  Drugs used in the treatment of obesity to top
04.05.01  Anti-obesity drugs acting on the gastro-intestinal tract
Orlistat
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Formulary  
   
04.05.02  Centrally acting appetite suppressants
04.06  Drugs used in nausea and vertigo
04.06  Vomiting during pregnancy
Cyclizine
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First Choice Tablets
Injection 
Promethazine Hydrochloride
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First Choice Tablets
Elixir
Injection 
Prochlorperazine
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Second Choice Tablets
Buccal tablets (Buccastem®)
Syrup
Injection 
   
Metoclopramide
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Second Choice Tablets
Oral solution
Injection 
   
04.06  Postoperative nausea and vomiting to top
Cyclizine
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First Choice Tablets
Injection 
Prochlorperazine
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First Choice Tablets
Buccal tablets (Buccastem®)
Syrup
Injection 
Ondansetron
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Formulary
Green 3
Tablets
Injection
Oral lyophilisates (’melts’)
Suppositories


Green Traffic Light For exceptional use in non-oncology patients with chronic emesis following consultant recommendation and where all other options have failed  
   
04.06  Motion sickness
Hyoscine Hydrobromide
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First Choice Tablets
Patches 
Cinnarizine
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Second Choice Tablets 
   
Cyclizine
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Formulary Tablets
Injection 
   
04.06  Other vestibular disorders
Betahistine
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Formulary Tablets 
   
04.06  Cytotoxic chemotherapy
04.06  Palliative care
 note 

If commencing an anti-emetic for opioid-induced nausea and vomiting, review and consider stopping after seven days.

Cyclizine
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First Choice Tablets
Injection 
Metoclopramide
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First Choice Tablets
Suspension
Injection 
Haloperidol
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First Choice Tablets
Capsules
Oral liquid
Injection 
Levomepromazine
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Second Choice
Green 1
Tablets
Injection

noteIn the last days of life, levomepromazine is used as a first-line antiemetic. 
   
Dexamethasone
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Formulary Tablets
Oral solution
Injection 
   
04.06  Antihistamines to top
Cinnarizine
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Formulary  
   
Cyclizine
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Formulary Tablets
Injection 
   
Promethazine Hydrochloride
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Formulary Tablets
Elixir
Injection 
   
04.06  Phenothiazines and related drugs
Levomepromazine
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Formulary Tablets
Injection 
   
Prochlorperazine
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Formulary Tablets
Buccal tablets (Buccastem®)
Syrup
Injection 
   
04.06  Domperidone and metoclopramide
Domperidone
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Formulary Tablets
Suspension
unlicensedSuppositories (unlicensed) 
Link  MHRA Drug Safety Update: domperidone
   
Metoclopramide
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Formulary Tablets
Oral solution
Injection 
Link  MHRA Drug Safety Update: metoclopramide
   
04.06  5HT3 antagonists
Ondansetron
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First Choice Tablets
Oral lyophilisates ('melts')
Injection
Suppositories 
Palonosetron (Aloxi®)
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Second Choice Approved for emesis following breast cancer chemotherapy (2nd line after ondansetron) 
   
04.06  Hyoscine
Hyoscine Hydrobromide
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Formulary Tablets
Patch 
   
04.06  Other drugs for Ménière's disease to top
Betahistine Dihydrochloride
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04.07  Analgesics
04.07.01  Non-opioid analgesics and compound analgesic preparations
Paracetamol
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First Choice Tablets
Soluble tablets
Oral suspension
Suppositories
IV infusion
 
Nefopam
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Formulary
Grey
Tablets

Only to be used in those patients with moderate to severe chronic liver disease who require analgesia stronger than paracetamol in whom NSAIDS and moderate strength opiates are contraindicated
 
   
04.07.01  Compound analgesic preparations
 note  The advantages of analgesic preparations containing paracetamol with a low dose of an opioid have not been substantiated. The low dose of the opioid may be enough to cause opioid side-effects, yet may not provide significant additional relief of pain.
Paracetamol and codeine (Co-codamol® 8/500)
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Formulary Tablets
Effervescent tablets 
   
Paracetamol and codeine (Co-codamol® 30/500)
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Formulary Tablets
Effervescent tablets 
   
Paracetamol and dihydrocodeine (Co-dydramol® 10/500)
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Formulary Tablets 
   
04.07.02  Opioid analgesics
Codeine Phosphate
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First Choice Tablets
Oral liquid 
Controlled Drug Morphine
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First Choice Oral solution:
  • 10mg/5mL
  • 100micrograms/mL (unlicensedunlicensed)

    Concentrated oral solution:
  • 100mg/5mL

    Tablets

    M/R 12-hourly oral preparations:
  • Zomorph® capsules
  • MST® tablets

    M/R 24-hourly oral preparations:
  • MXL® capsules

    Suppositories

    Injection

    PCA syringe (unlicensedunlicensed)

     
  • Controlled Drug Tapentadol (Palexia®)
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    Third Choice
    Grey

    Prolonged-release tablets

    Tablets

    Oral solution

    • Third or fourth line option in those patients who have failed other therapies and are intolerant to oxycodone.
    • To be prescribed or initiated under the advice of a specialist in pain management only.

      Grey Traffic Light Use of this agent should be restricted to those patients requiring treatment of severe chronic pain which CANNNOT be managed with more established opioid therapies.
     
    Link  GMMMG recommendation: Tapentadol for treatment of severe pain
    Link  MHRA Safety Alert: risk of seizures and reports of serotonin syndrome
       
    Controlled Drug Buprenorphine
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    Formulary Patches (BuTrans® or Transtec®)
    S/L tablets (Temgesic®
       
    Controlled Drug Diamorphine
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    Formulary Injection 
       
    Dihydrocodeine
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    Formulary Tablets
    M/R tablets 
       
    Controlled Drug Fentanyl
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    Formulary Patches
    Restricted Item Buccal tablets (Effentora®) Palliative care only
    Restricted Item Nasal spray (PecFent®) Palliative care only
     
    Link  GMMMG IPNTS Recommendation: Fentanyl preparations
    Link  MHRA Safety Alert: Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure
       
    Controlled Drug Oxycodone
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    Formulary Immediate-release preparations (OxyNorm®):
  • Oral solution 5mg/5mL
  • Concentration oral solution 10mg/mL
  • Capsules
  • Injection

    M/R preparations (OxyContin®):
  • Tablets 
  •    
    Controlled Drug Pethidine
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    Formulary Tablets
    Injection 
       
    Controlled Drug Tramadol
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    Formulary Capsules
    Soluble tablets
    M/R tablets or capsules
    Injection 
    Link  UKMI Q&A: risk of developing Serotonin Syndrome following concomitant use of tramadol with SSRIs
       
    04.07.03  Neuropathic pain to top
    Gabapentin
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    First Choice Capsules
    Oral solution 
    Amitriptyline
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    First Choice Tablets
    Oral solution 
    Pregabalin
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    Formulary
    Green 1
    Capsules

    note A trial of pregabalin may be considered in patients who cannot tolerate gabapentin, or who have not responded fully despite an adequate trial. 
       
    Duloxetine (Cymbalta®)
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    Formulary Capsules

    noteDuloxetine may be considered as an option where other treatments have failed, or for a clear diagnosis of diabetic neuropathy. 
       
    Imipramine
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    Formulary Tablets
    Oral solution 
       
    Ketamine oral solution
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    Restricted Drug Restricted
    Red

    Specialist initiation by pain team or palliative care only
    unlicensed Unlicensed

     
       
    04.07.03  Trigeminal neuralgia
    Carbamazepine
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    First Choice Tablets
    M/R tablets
    Liquid
    Suppositories
     
    Gabapentin
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    Second Choice Capsules
    Oral solution 
    Link  MHRA Safety Update: Risk of severe respiratory depression
       
    04.07.04  Antimigraine drugs
    04.07.04.01  Treatment of the acute migraine attack
    04.07.04.01  Analgesics
    Migraleve®
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    Formulary "Pink" tablets (buclizine 6.25mg, paracetamol 500mg, codeine phosphate 8mg)
    "Yellow" tablets (paracetamol 500mg, codeine phosphate 8mg)
     
       
    04.07.04.01  5HT1 agonists to top
    Sumatriptan
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    Formulary Tablets
    Injection 
       
    04.07.04.01  Anti-emetics
     note  Antiemetics such as metoclopramide, domperidone, or phenothiazine and antihistamine antiemetics, relieve the nausea associated with migraine. See section 4.6.
    04.07.04.02  Prophylaxis of migraine
    Propranolol
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    First Choice Tablets
    M/R capsules
    Oral solution 
    Topiramate
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    Second Choice Tablets
    Sprinkle® capsules

    Grey Traffic Light Topiramate hard capsules are expensive and should not be prescribed. For those patients unable to swallow topiramate tablets “sprinkle capsules” may be considered  
       
    Pizotifen
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Tablets 
       
    04.07.04.03  Cluster headache
    Sumatriptan
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Injection 
       
    04.08  Antiepileptics
     note 

    The MHRA has advised that antiepileptic drugs should be classified into 3 categories with respect to switching between brands:
    Category 1 – Ensure patients are maintained on a specific manufacturer’s product: phenytoin, carbamazepine, phenobarbital, primidone
    Category 2 - The need for continued supply of a particular manufacturer’s product should be based on clinical judgement, taking account of factors such as seizure frequency and treatment history: valproate, lamotrigine, perampanel, retigabine, rufinamide, clobazam, clonazepam, oxcarbazepine, eslicarbazepine, zonisamide, topiramate
    Category 3 – Usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety, risk of confusion or dosing errors: levetiracetam, lacosamide, tiagabine, gabapentin, pregabalin, ethosuximide, vigabatrin

    Initiation and withdrawal of therapy must only be managed by a specialist.

    04.08.01  Control of epilepsy to top
    04.08.01  Partial seizures with or without secondary generalisation
    04.08.01  Generalised seizures
    04.08.01  Carbamazepine and Oxcarbazepine
    Carbamazepine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets
    M/R tablets
    Liquid
    Suppositories

    note Ensure patients are maintained on a specific manufacturer's product / brand 
    Link  MHRA Recommendation: Switching between brands of antiepileptics
    Link  UKMI Q&A: Why is there a limit on the dose and duration of use for carbamazepine suppositories?
       
    Oxcarbazepine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets 
       
    04.08.01  Ethosuximide
    Ethosuximide
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Capsules
    Syrup 
       
    04.08.01  Gabapentin and pregabalin to top
    Gabapentin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Capsules
    Oral solution 
    Link  MHRA Safety Update: Risk of severe respiratory depression
       
    Pregabalin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Capsules

    FOR EPILEPSY. See section 4.7.3 for use in neuropathic pain.  
       
    04.08.01  Lacosamide
    Lacosamide
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets
    Syrup 
       
    04.08.01  Lamotrigine
    Lamotrigine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets
    Dispersible tablets 
       
    04.08.01  Levetiracetam
    Levetiracetam (Keppra®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets
    Oral solution
    Intravenous infusion 
       
    04.08.01  Phenobarbital and other barbiturates
    Controlled Drug Phenobarbital
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets
    Elixir
    Injection

    note Ensure patients are maintained on a specific manufacturer's product / brand 
    Link  MHRA Recommendation: switching between brands of anti-epileptics
       
    Primidone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets

    note Ensure patients are maintained on a specific manufacturer's product / brand 
    Link  MHRA Recommendation: switching between brands of anti-epileptics
       
    04.08.01  Phenytoin to top
    Phenytoin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Capsules
    Suspension 30mg/5mL
    Chewable tablets
    Injection

    note Ensure patients are maintained on a specific manufacturer's product / brand 
    Link  MHRA Recommendation: Switching between brands of anti-epileptics
    Link  PAT Loading Doses Policy
    Link  Patient Safety Alert: Risk of death and severe harm from error with injectable phenytoin
    Link  UKMi Q&A: How can we minimise the risk to patients when using IV phenytoin?
       
    04.08.01  Retigabine
    Retigabine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    Tablets

     
    Link  MHRA Safety Update: restrict to last-line use
    Link  NICE TA232: Retigabine
       
    04.08.01  Rufinamide
    Rufinamide
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 3
     
    Link  GMMMG IPNTS Recommendation: Rufinamide (Inovelon®▼) in the treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients four years and older.
       
    04.08.01  Tiagabine
    Tiagabine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets
     
       
    04.08.01  Topiramate
    Topiramate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets
    Sprinkle® capsules

    Grey Traffic Light Topiramate hard capsules are expensive and should not be prescribed. For those patients unable to swallow topiramate tablets “sprinkle capsules” may be considered  
       
    04.08.01  Valproate to top
    Sodium Valproate
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets (e/c)
    Crushable tablets
    M/R tablets
    Syrup
    Injection
     
    Link  MHRA Drug Safety Update: Valproate and abnormal pregnancy outcomes
    Link  MHRA Patient Safety Alert: Resources to support the safe use of valproate
    Link  Risk Minimisation Materials - to help reduce the risk associated with using valproate
       
    04.08.01  Vigabatrin
    Vigabatrin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Tablets
    Powder sachets 
       
    04.08.01  Zonisamide
    Zonisamide
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Capsules 
       
    04.08.01  Benzodiazepines
    Clobazam
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets
    Oral suspension 
       
    Clonazepam
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets
    Injection 
       
    04.08.01  Other Drugs
    Perampanel (Fycompa®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets 
    Link  GMMMG: Perampanel for the adjunctive treatment of partial onset seizures
       
    04.08.02  Drugs used in status epilepticus to top
     note 

    If status epilepticus persists longer than 45 minutes, the patient may need to be sedated, paralysed, intubated and ventilated; and subsequently admitted to a critical care unit. The on-call anaesthetist and medical consultant should be informed.

    Lorazepam Injection
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice  
    Diazepam
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice Injection (emulsion)
    Rectal tubes (rectal solution)

    note Use diazepam injection as first-line alternative only if lorazepam injection not available

     
    Controlled Drug Midazolam Buccal Solution (Buccolam®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green 3
    Restricted Item Paediatric use only 
    Phenytoin Injection
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice Loading Dose See loading doses policy 
    Link  Loading Doses Policy
    Link  Patient Safety Alert: Risk of death and severe harm from error with injectable phenytoin
    Link  UKMi Q&A: How can we minimise the risk to patients when using IV phenytoin
       
    Paraldehyde Enema
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Restricted Item Paediatric use only 
       
    Controlled Drug Phenobarbital Injection
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary  
       
    04.08.03  Febrile convulsions
    04.09  Drugs used in parkinsonism and related disorders
    04.09.01  Dopaminergic drugs used in Parkinsons disease
    04.09.01  Dopamine receptor agonists
    Pramipexole
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green 2
    Tablets
    M/R tablets 
    Ropinirole
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green 2
    Tablets
    M/R tablets 
    Rotigotine Patch
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Green 2
    Only for patients unable to tolerate or comply with oral medication. 
    Link  PAT Management of Parkinson’s Disease in Patients who are nil by mouth (NBM) or have compromised swallow
       
    Apomorphine Injection
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
    Amber
    Initiation on the recommendation of a movement disorder specialist only 
    Link  PAT Management of Parkinson’s Disease in Patients who are nil by mouth (NBM) or have compromised swallow
       
    Cabergoline
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets 
    Link  MHRA Drug Safety Update: risk of fibrotic reactions
       
    Pergolide
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets 
    Link  MHRA Drug Safety Update: risk of fibrotic reactions
       
    04.09.01  Levodopa to top
    Co-Beneldopa (Madopar®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green 2
    Capsules
    Dispersible tablets
    M/R capsules 
    Co-Careldopa (Sinemet®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green 2
    Tablets
    M/R tablets 
    Co-Careldopa and Entacapone (Stalevo®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets 
       
    04.09.01  Monoamine-oxidase-B inhibitors
    Selegiline Hydrochloride
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Tablets 
       
    Safinamide (Xadago)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 3
    Tablet 
    Link  GMMMG: Safinamide for the management of Parkinson’s Disease
       
    04.09.01  Catachol-O-methyltransferase inhibitors
    Entacapone
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green 2
     
    Opicapone (Ongentys®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green 3
    Capsules 
    Link  GMMMG: Opicapone for the managment of Parkinson’s Disease
       
    04.09.01  Amantadine
    Amantadine Hydrochloride
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Capsules
    Syrup 
       
    04.09.02  Antimuscarinic drugs used in parkinsonism
    Trihexyphenidyl
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green 1
    Tablets
    Syrup 
    Orphenadrine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Tablets
    Oral liquid 
       
    Procyclidine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Tablets
    Syrup
    Injection 
       
    04.09.03  Drugs used in essential tremor, chorea, tics, and related disorders to top
    Primidone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Tablets 
       
    Propranolol
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Tablets
    M/R capsules
    Oral solution 
       
    Riluzole
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    Tablets 
    Link  NICE TA20: Motor neurone disease - riluzole
       
    Tetrabenazine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Tablets 
       
    04.09.03  Torsion dystonias and other involuntary movements
    Botulinum Toxin Type A (Botox®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary  
       
    Botulinum Toxin Type A (Dysport®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary  
       
    04.10  Drugs used in substance dependence
    04.10.01  Alcohol dependence
    Chlordiazepoxide
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice Capsules 
    Acamprosate
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green 1
    Gastro-resistant tablets

    Green Traffic Light Only in conjunction with specialist service 
    Disulfiram (Antabuse®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber
    Restricted Item Specialist initiation only 
       
    Naltrexone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Tablets 
       
    04.10.02  Nicotine dependence
    Nicotine (Nicorette® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Patch (16 hour)
    Chewing gum
    S/L tablets
    Inhalator

     
       
    Nicotine (Nicotinell®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Patch (24 hour)
    Lozenge 
       
    04.10.03  Opioid dependence to top
    04.10.03  Opioid substitution therapy
    Controlled Drug Methadone
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice Solution
    Injection 
    Controlled Drug Buprenorphine (Subutex®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 2
    Sublingual tablets 
       
    04.10.03  Adjunctive therapy and symptomatic treatment
    Lofexidine Hydrochloride
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted Specialist initiation only 
       
    04.10.03  Opioid-receptor antagonists
    Naltrexone
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted Specialist initiation only 
    Link  NICE TA115: Drug misuse - naltrexone
       
    04.11  Drugs for dementia
    Donepezil
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green 3
    Tablets
    Orodispersible tablets

    Green Traffic Light Commissioning arrangements may vary and in some localities this is Green2 - check with relevant CCG 
    Galantamine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 3
    Tablets
    M/R capsules
    Oral solution

    Green Traffic Light Commissioning arrangements may vary and in some localities this is Green2 - check with relevant CCG 
       
    Memantine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 3
    Tablets
    Oral solution

    Green Traffic Light Commissioning arrangements may vary and in some localities this is Green2 - check with relevant CCG 
       
    Rivastigmine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green 3
    Capsules
    Oral solution
    Patch

    Green Traffic Light Commissioning arrangements may vary and in some localities this is Green2 - check with relevant CCG 
    Link  UKMi Q&A: How to minimise the risks of medication errors with rivastigmine patches
    Link  GMMMG Recommendation: Rivastigmine for the management of dementia with Lewy Bodies
       
     ....
     Non Formulary Items
    Acetazolamide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Almotriptan  (Almogran®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Alprazolam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Amitriptyline and perphenazine  (Triptafen®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Amobarbital (amylobrbitone)  (Sodium Amytal®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Aspirin and metoclopramide  (MigraMax®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Benperidol  (Anquil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Benzatropine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Botulinum Toxin Type A  (Azzalure®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Botulinum Toxin Type A  (botox®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Link  NICE TA260: Botox for migraine prophylaxis
     
    Botulinum Toxin Type A  (Vistabel®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Botulinum Toxin Type B  (NeuroBloc®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Bromocriptine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Buprenorphine and Naloxone  (Suboxone®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Bupropion Hydrochloride  (Zyban®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Butobarbital (butobarbitone)  (Soneryl®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Chloral Hydrate  (Chloral Elixir®, Paediatric, BP 2000)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Chlorpromazine Hydrochloride

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Cinnarizine and Dimenhydrinate  (Arlevert®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Clonidine Hydrochloride

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Cloral Betaine  (Welldorm®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Clozapine  (Denzapine®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Co-Careldopa  (Duodopa®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Diazepam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dolasetron Mesilate  (Anzemet®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dosulepin

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    Capsules
    Tablets

    Dosulepin should NOT be initiated in new patients.
     
    Doxepin  (Sinepin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Droperidol  (Xomolix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Eletriptan  (Relpax®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Eslicarbazepine  (Zebinix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Fentanyl  (Actiq®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Fentanyl  (Instanyl® nasal spray)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Fentanyl sublingual tablets  (Abstral®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fluphenazine Hydrochloride  (Moditen®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Flurazepam  (Dalmane®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fosphenytoin Sodium  (Pro-Epanutin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Frovatriptan

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Granisetron  (Kytril®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Red
     
    Haloperidol  (Dozic®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Haloperidol  (Haldol®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Haloperidol  (Serenace®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Hydromorphone  (Palladone®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
     
    Lithium Carbonate  (Liskonum®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Loprazolam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lurasidone  (Latuda®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Melatonin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Link  UKMI Q&A: review of effectiveness in cluster headache
     
    Meptazinol  (Meptid®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Morphine and cyclizine  (Cyclimorph®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Nalmefene

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Naratriptan  (Naramig®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Olanzapine Embonate  (ZypAdhera®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Paliperidone

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Amber
     
    Paliperidone  (Xeplion®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Amber
     
    Controlled Drug  Papaveretum

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Paracetamol

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Paracetamol and metoclopramide  (Paramax®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Pentazocine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Perphenazine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Pethidine Hydrochloride and promethazine  (Pamergan® P100)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Piracetam  (Nootropil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Prochlorperazine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Rasagiline  (Azilect®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Green 2
     
    Rizatriptan  (Maxalt®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Secobarbital (quinalbarbitone)  (Seconal Sodium® )

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sodium valproate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sulpiride  (Dolmatil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sulpiride  (Sulpor®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Targinact® (Oxycodone/Naloxone)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Link  GMMMG Recommendation: Targinact
     
    Tolcapone  (Tasmar®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tolfenamic Acid  (Clotam®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tramadol Hydrochloride and paracetamol  (Tramacet®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Trifluoperazine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Trifluoperazine  (Stelazine®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Trimipramine

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Capsules
    Tablets

     
    Tropisetron  (Navoban®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Varenicline  (Champix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Link  NICE TA123: Varenicline
     
    Zaleplon  (Sonata®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Zolmitriptan

    View adult BNF View SPC online View childrens BNF
    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 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

    Amber

    Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

    Black

    These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

    Green

    Not used   

    Green 1

    Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

    Green 2

    Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

    Green 3

    Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

    Grey

    Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

    Red

    Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

    netFormulary