Lancashire and South Cumbria
Formulary
 
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4 Central nervous system
04-02-01 Second-Generation Antipsychotic Drugs

The balance of risk and benefit should be considered and discussed with the patient or carers before prescribing antipsychotic drugs for elderly patients. In elderly patients with dementia, the use of antipsychotic drugs are associated with a small increased risk of mortality and an increased risk of stroke or transient ischaemic attack. 

 

 


Amisulpride
Formulary

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

Schizophrenia.

Link  LSCMMG: Shared care guideline
Link  MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity

Amber 1 View adult BNF  View SPC online  View childrens BNF
Aripiprazole Abilify®
Formulary

Tablets 5mg,10mg,15mg, 30mg
Orodispersible tablets 10mg,15mg
Oral solution 1mg/ml

Orodispersible tablets and oral solution for use in swallowing difficulties only.

Consultant psychiatrist initiation only.

When prescribing, dispensing, or administering, check that the correct preparation is used—the preparation usually used in hospital for the rapid control of an acute episode (solution for injection containing aripiprazole 7.5 mg/mL) should not be confused with depot preparations (powder and solvent for prolonged-release suspension for injection), which are usually used in the community or clinics for maintenance treatment.

Red Alternating hemiplegia under specialist supervision.
Amber 1 Bipolar disorder in Adults
Red Bipolar disorder in Adolescents (NICE TA292)
Amber 1 Treatment of Schizophrenia in adults.
Amber 1 Treatment of Schizophrenia in people aged 15 to 17 years (NICE TA213)

Link  LSCMMG: Shared care guideline
Link  MHRA: Aripiprazole (Abilify and generic brands): risk of pathological gambling
Link  MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 to 17 years
Link  NICE TA292: Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder

Multiple View adult BNF  View SPC online  View childrens BNF
Cariprazine Reagila®
Formulary

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

Schizophrenia in adult patients.

Second-line therapy in patients where predominantly negative symptoms have been identified as an important feature. Requires prior approval by Lead Pharmacist before initiation.

Link  LSCFT - Cariprazine medicine request form
Link  LSCMMG: Shared care guideline

Amber 1 View adult BNF  View SPC online  View childrens BNF
Clozapine
Formulary

Tablets 25mg, 100mg

Liquid 100mg/5mL

Injection

Treatment resistant/intolerant schizophrenia Psychosis in
Parkinson’s disease.

LSCFT use only - Clinicains to refer to the clozapine procedure.

Link  LSCFT - Clozapine injection medication request form

Red View adult BNF  View SPC online  View childrens BNF
Lurasidone Latuda®
Formulary

Tablets 18.5mg, 37mg, 74mg

Schizophrenia in adults aged 13 and over.

LSCFT initiated only

Lurasidone will be supplied by the specialist service for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Lurasidone may only be prescribed in the following circumstances:
1. The patient has previously had a trial of and has not responded to aripiprazole
2. The patient does not fulfil the treatment resistance criteria as outlined in NICE Clinical Guideline 178 for the initiation of prescribing of clozapine
3. The patient has:
a. a metabolic disorder, diabetes or obesity or
b. pre-existing risk factors for metabolic disease, diabetes or obesity
All requests for lurasidone will be screened by LSCFT

Link  LSCFT - Lurasidone medicine request form

Red View adult BNF  View SPC online  View childrens BNF
Olanzapine
Formulary

Tablets 2.5mg, 5mg, 7.5mg, 10mg, 15mg
Orodispersible tablets 5mg, 10mg, 15mg, 20mg

Schizophrenia and moderate to severe manic episodes and preventing reoccurrence in bipolar disorder.

Link  LSCMMG: Shared care guideline
Link  MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity

Amber 1 View adult BNF  View SPC online  View childrens BNF
Quetiapine
Formulary

Tablets, m/r tablets.

Please prescribe MR tablets by brand.

The XL version is only version licensed as an add-on treatment of major depressive episodes in patients with Major Depressive Disorder who have had sub-optimal response to antidepressant monotherapy.

Brancico XL, Zaluron XL tablets, Sondate XL 150mg, XL 200mg, XL 300mg, XL 400mg tablets [PRESCRIBE BY BRAND].

LSCFT initiated only

Schizophrenia, manic episodes associated with bipolar disorder, major depressive episodes in bipolar disorder, preventing recurrence in bipolar disorder. LSCFT: Approval should be sought from Locality Lead Pharmacist prior to initiation of XL for major depressive disorder.

Link  LSCFT - Quetiapine XL medicine request form
Link  LSCMMG: Shared care guideline

Amber 1 View adult BNF  View SPC online  View childrens BNF
Risperidone
Formulary

Tablets 500micrograms, 1mg, 2mg, 3mg, 4mg
Orodispersible tablets 500micrograms, 1mg, 2mg
Oral solution 1mg/mL

Schizophrenia, moderate to severe manic episodes associated with bipolar disorders, shortterm treatment (up to 6 weeks) of persistent aggression in patients with moderate to severe Alzheimer's dementia unresponsive to non-pharmacological approaches and when there is a risk of harm to self or others, short-term symptomatic treatment (up to 6 weeks) of persistent aggression in conduct disorder in children from the age of 5 years and adolescents with subaverage intellectual functioning or mental retardation diagnosed according to DSM-IV criteria, in whom the severity of aggressive or other disruptive behaviours require pharmacologic treatment. May be used for longer periods (off-label) in conduct disorder with autistic spectrum condition or severe learning disability.

Link  LSCMMG: Shared care guideline
Link  MHRA: Recent drug-name confusion
Link  MHRA: Risperidone and paliperidone: risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery

Amber 1 View adult BNF  View SPC online  View childrens BNF
Olanzapine Depot Injection
Formulary

Schizophrenia.


Do Not Prescribe View adult BNF  View SPC online  View childrens BNF