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West joint prescribing formulary

Chapter 4 – DRUGS ACTING ON CENTRAL NERVOUS SYSTEM Category
Drug name
Strength / dose / form
BCU Comments
4.1 – Hypnotics and anxiolytics
4.1.1 Hypnotics

Benzodiazepine mazepam
4.1.2 Anxiolytics
Benzodiazepine

Beta blockers
4.2 – Drugs used in psychoses and related disorders
4.2.1

Antipsychotic
Restricted to specialist psychiatric use only
Restricted to specialist psychiatric use only - for rapid
tranquillisation only
Atypical
antipsychotic
Orodispersible – restricted patients with swallowing/compliance
Consultant psychiatric use only for treatment of resistant
schizophrenia

i/m injection for rapid tranquillisation – specialist psychiatric inpatient use
only. NB Olanzapine depot – NOT included (Not AWMSG approved)
Orodispersible – restricted patients with swallowing/compliance
issues

XL preparation is approved as a treatment option for schizophrenia
by AWMSG

Orodispersible – restricted patients with swallowing/compliance
issues

Category
Drug name
Strength / dose / form
BCU Comments
Antipsychotic
injections
Injection hospital supply only as needs refrigeration
4.2.3 Antimanic
drugs
Carbamazepine
Valproate
“Epilim” and “Epilim Chrono” – unlicensed use
Antipsychotic
i/m injection for rapid tranquillisation – specialist psychiatric inpatient use only
Orodispersible – restricted patients with swallowing/compliance
issues

XL preparation is NOT approved as a treatment option for manic episodes associated with bipolar disorder by AWMSG Orodispersible – restricted patients with s swallowing/compliance
issues

Lamotrigine
4.3 – Antidepressant drugs
4.3.1 Tricyclic
and related
antidepressant
Tricyclic
related
antidepressant
s
4.3.2

Monoamine-
oxidase
inhibitors
(MAOIs)

Category
Drug name
Strength / dose / form
BCU Comments
Reversible
MAOIs
4.3.3 Selective

serotonin
reuptake
inhibitors
4.3.4 Other

Initiated by mental health team only
antidepressant
Initiated by mental health team only
2nd choice When other drugs are not tolerated or are ineffective specialist
initiation only – high doses ≥ 300mg daily hosp
Scriptswitch VENLALIC XL MR tablets or VENAXX XL MR capsules
4.4 – CNS stimulants and drugs used for attention deficit hyperactivity disorder
CAMHS use only shared care needed
CAMHS use only shared care needed
only shared care needed
4.5 – Drugs used in the treatment of obesity
4.5.1 Anti-

As per NICE guidance - Limited value without behavioural and diet
obesity drugs
acting on the
gastro-
intestinal tract
4.6 – Drugs used in nausea and vertigo
Antihistamines

Phenothiazines
and related
Palliative care use only
Domperidone
metoclopramide
5HT

antagonists
Hyoscine
Neurokinin
Not listed but approved 2nd line. Anti-emetic policy review request. Funding Receptor
Antagonist
Category
Drug name
Strength / dose / form
BCU Comments
(Steroid)
palliative review
Other drugs for
Meniere’s
disease
4.7 - Analgesics
4.7.1 Non-

analgesics
(special)
1g/100mL infusion ▼
as an alternative to opiates or NSAIDs where their use is contra-
indicated or inappropriate, or where oral or rectal administration is
not tolerated.

1st line choice on basis of safety
Hospital only - Use post-op in patients NBM in order to get NSAID into 3rd line agent following MHRA warning
3rd line agent following MHRA warning
3rd line agent following MHRA warning
2nd line choice
Non-opioid and
weak opioid
Hospital only - use post-surgery
compound
analgesic
preparations
4.7.2 Opioid

analgesics
Patches prescribe by brand name. Matrifen preferred Category
Drug name
Strength / dose / form
BCU Comments
palliative review
palliative review
palliative review
palliative review
Morphine sulphate immediate Liquid, tablets and Liquid – “Oramorph” , Tablets – “Sevredol” palliative review
Neuropathic
Included in the NICE CG for Neuropathic Pain Included in the NICE CG for Neuropathic Pain. Use bd Trigeminal
neuralgia
4.7.4 – Antimigraine drugs
4.7.4.1

Treatment of
acute migraine
Analgesics

5HT1 agonists
Tablets 1st line choice – off patent and most cost effective product
Antiemetics
Prophylaxis of
migraine

Category
Drug name
Strength / dose / form
BCU Comments
4.8 Antiepileptic drugs
4.8.1 Control of

The Walton Centre does not have any epilepsy guidelines.
epilepsy
New NICE CG for epilepsy due in spring 2011. Carbamazepine
Prescribe by brand
and related
antiepileptics
Ethosuximide

analogues
Lamotrigine
Prescribe by brand
Levetiracetam
Phenobarbital
Included for continuation therapy only (not usually initiated) and other
barbiturates
Phenytoin

Included for continuation therapy (not usually initiated)
Prescribe by brand
Topiramate
Valproate
Prescribe by brand
Vigabatrin
Zonisamide
Benzodiazepine
4.8.2 Drugs
used in status
epilepticus
Special - Buccal midazolam Alternative to IV lorazepam in times of supply issues 4.9 – Drugs used in parkinsonism and related disorders
4.9.1 Dopaminergic drugs used in parkinsonism

Dopamine
receptor
agonists
for those patients for whom oral treatments have been tried and are found to be either ineffective or not tolerated Category
Drug name
Strength / dose / form
BCU Comments
Levodopa
Monoamine-
oxidase-B
inhibitors
COMT

inhibitors
Amantadine
Antimuscarinic
drugs used in
parkinsonism
4.9.3 Drugs
choreas, tics
and related
disorders

4.10 – drugs used in substance dependence
Alcohol

dependence
Cigarette
If a 16 hour patch is required, use the 24 hour patch and remove after 16 21mg over 24 hours) Nicotinell® 2mg, 4mg chewing gum in fruit and mint flavour Nicotinell® 1mg, 2mg mint lozenge Nicorette® 10mg inhalator For continuation of therapy as per NICE guidance
Category
Drug name
Strength / dose / form
BCU Comments
As advised by substance abuse consultant only dependence
As advised by substance abuse consultant only As advised by substance abuse consultant only Only initiated after patient reviewed by Drug & Alcohol Service As advised by substance abuse consultant only 4.11 – Drugs for dementia

Source: https://www.whatdotheyknow.com/request/99021/response/246778/attach/7/362%2011%20FOI%20Chapter%204%20CNS.pdf

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