Tablets 3.75mg, 7.5mg

First line short-term hypnotic.

If commenced in hospital, not to be continued at discharge.
May have CD status in some hospital Trusts, refer to local policy.

Tablets 25mg, 50mg

Treatment of long-term insomnia

Children with learning disabilities

Children with ADHD

Children and adolescents with Autism Spectrum Disorder (ASD) and / or Smith-Magenis syndrome

Cerebral palsy

Children with complex neurodevelopmental disorders that the specialist considers eligible

Initiation of melatonin must be by a specialist in the indication being prescribed for and have a clear plan for review.

Prescribing and review of melatonin in children must follow the principles outlined in the Melatonin Pathway (Children)

For the Treatment of Rapid Eye Movement (REM) Sleep Behaviour Disorder (RBD) in Parkinson’s Disease and Lewy Body Dementia

Adults with learning disabilities

Sleep disturbance in adults with ADHD

Sleep disorders in the blind

Adults with complex neurodevelopmental disorders that the specialist considers eligible

Initiation of melatonin must be by a specialist in the indication being prescribed for and have a clear plan for review.

Prescribing and review of melatonin in adults must follow the principles outlined in the Melatonin Pathway (adults) **Under development**.

Melatonin is suitable for prescribing for the treatment of REM RBD in PD and LBD when clonazepam is not considered to be appropriate.

Primary insomnia in those over 55

Sleep problems in patients with dementia associated with Alzheimer’s

Colonis liquid 1mg/ml and 3mg tablets for all indications, including insomnia and jet lag

Tablets 5mg, 10mg

If commenced in hospital, not to be continued at discharge.

Tablets 5mg
Liquid 2.5mg/5mL

Insomnia (short term use).

Tablets 10mg
Liquid 10mg/5mL

Insomnia (short term use).

Insomnia (short term use).

Liquid 500mg/5mL

BNF considers promethazine less suitable for prescribing than alternatives for insomnia.

Oral solution 500mg/mL

Narcolepsy with cataplexy (under expert supervision)

Capsules

Generalised Anxiety Disorder (GAD).

Anxiety (short term use).

Tablets 2mg, 5mg, 10mg
Liquid 2mg/5mL
Rectal tubes 5mg/2.5mL, 10mg/2.5mL

Anxiety.

Tablets 1mg

Short term use in anxiety and insomnia.

Capsules 5mg, 10mg

Chlordiazepoxide is also used in a reducing regime for the management of acute alcohol withdrawal. See trust Clinical Guidelines.

Tablets 10mg, 15mg

Depending on local protocols, Oxazepam may be usedfor in-patient alcohol detoxification of patients with significant hepatic impairment where a short-acting benzodiazepine would be preferred.

Anxiety.

Tablets 10mg, 40mg, 80mg
M/R capsules 80mg, 160mg

Anxiety.

Note: significant risks when taken in overdose. Potential for rapid deterioration before medical assistance is received.

Short term use in anxiety.

Tablets 250mcg 

Control of deviant antisocial sexual behaviour.

LSCFT consultant initiation only.

Tablets 10mg, 25mg, 50mg, 100mg
Liquid 25mg/5mL, 100mg/5mL

Schizophrenia and other psychoses, mania, anxiety, agitation, violent or dangerously impulsive behaviour, childhood schizophrenia.

 Injection

Tablets 500microgram, 1mg, 3mg

Schizophrenia and psychoses.

 for depression

Tablets 1.5mg, 5mg, 10mg
Oral liquid 10mg/5mL, 5mg/ 5mL

Schizophrenia and other psychoses, mania, anxiety.

Injection 5mg/1mL

Injection for rapid tranquilisation.

Haloperidol injection should be used in combination with promethazine injection for rapid tranquillisation.

This preparation is usually used in hospital for the rapid control of an acute episode and should not be confused with depot preparations of haloperidol decanoate which are usually used in the community or clinics for maintenance treatment.

Tablets 25mg, 50mg
Liquid 25mg/5mL, 50mg/5mL

Short-term management of psychomotor agitation, agitation and restlessness in the elderly.

Tablets 200mg
Liquid 200mg/5mL

Schizophrenia.

Tablets 1mg
Liquid 1mg/5mL, 5mg/5mL

Schizophrenia and other psychoses, short term management of severe anxiety, psychomotor agitation, violent or dangerously impulsive behaviour, severe anxiety.

Tablets 2mg, 10mg, 25mg

Schizophrenia and other psychoses.

Injection 50mg/1mL

Short term managementof acute psychosis, mania or exacerbations of chronic psychosis.  

This preparation is usually used in hospital for an acute episode and should not be confused with depot preparations which are usually used in the community or clinics for maintenance treatment.

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

Schizophrenia.

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.

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

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.

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.

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

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.

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.

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.

Schizophrenia.

Prolonged release suspension for injection 400mg

LSCFT initiation only.

Schizophrenia in adult patients stabilised on oral aripiprazole. 

Application from RMO to be sent to Chief Pharmacist and Medical Director requesting its use.

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.

Injection 20mg/1mL, 40mg/2mL
Concentrate injection 50mg/0.5mL, 100mg/1mL

Maintenance in schizophrenia and other psychoses. 

Maintenance in schizophrenia and other psychoses. 

Licensed product no longer available. Where patients have deteriorated following a switch to an alternative depot antipsychotic a request can be made to use the unlicensed product should be made to the Lead Pharmacist in the locaility. 

Injection 50mg/1mL, 100mg/1mL

Maintenance in schizophrenia and other psychoses.

When prescribing, dispensing or administering, check that this is the correct preparation—this preparation is used for maintenance treatment and should not be used for the rapid control of an acute episode.

Pre-filled syringes 50mg, 75mg, 100mg, 150mg - monthly injection

Pre-filled syringes 175mg, 263mg, 350mg, 525mg (Trevicta) - 3-monthly injection

 Pre-filled syringes 700mg, 1000mg (Byannli) - 6-monthly injection

LSCFT initiation only.

Maintenance treatment of schizophrenia in adult patients.

For the monthly injection (Xeplian) and for Aripiprazole LAI: Application from RMO to be sent to Chief Pharmacist and Medical Director requesting its use.

The three monthly injection (Trevicta) if approval has been given for the monthly paliperidone depot there is no requirement for a further request to be sent to request a move to the three monthly option.

Schizophrenia. 

Licensed product no longer available. Where patients have deteriorated following a switch to an alternative depot antipsychotic a request can be made to use the unlicensed product should be made to the Lead Pharmacist in the locaility.

Injection 25mg, 37.5mg, 50mg

Schizophrenia.

Nonformulary in LSCFT.

Consultant psychiatrist initiation only.
Request from doctor must be sent to chief pharmacist and medical director of LSCFT before authorised to prescribe.

Injection 200mg/1mL
Concentrate injection 500mg/1mL

Maintenance in schizophrenia and other psychoses.

When prescribing, dispensing, or administering, check that this is the correct preparation—this preparation is used for maintenance treatment and should not be used for the short-term management of an acute episode.

Zuclopenthixol decanoate has been confused with zuclopenthixol acetate; care must be taken to ensure the correct drug is prescribed and dispensed.

Tablets 25mg, 50mg, 100mg, 200mg

Dispersible tablets 5mg, 25mg, 100mg

Bipolar disorder.

Prevention of depressive episodes in adult patients with bipolar I disorder who experience predominantly depressive episodes.

Dose titration required. See BNF/SPC for further information on titration, titration with valproate, and tritration with enzyme inducing drugs.
Consider withdrawal if rash or signs of hypersensitivity syndrome develop. See BNF/SPC for more detail.

Tablets 500micrograms, 2mg
Oral solution 500micrograms/5mL, 2mg/5ml

 for use in all forms of epilepsy and in the treatment of mood disorders

 for the treatment of anxiety (off-label indication)

Clonazepam has been confused with clobazam; care must be taken to ensure the correct drug is prescribed and dispensed. 

Other than epilepsy the use of clonazepam is off-labeL.

ablets 100mg, 200mg, 400mg
Modified-release tablets 200mg, 400mg

Liquid 100mg/5mL
Suppositories 125mg, 250mg

Prophylaxis of bipolar disorder unresponsive to lithium.

Mood stabiliser (unlicensed indication)

E/C tablets 250mg, 500mg

Manic episodes associated with bipolar disorder.

Modified-release tablets 400mg

Treatment and prophylaxis of mania, bipolar disorder and recurrent depression. Aggressive or self-mutilating behaviour.

M/R tablets 200mg, 400mg

Treatment and prophylaxis of mania, bipolar disorder and recurrent depression. Aggressive or self-mutilating behaviour.

Liquid 520mg/5mL

Treatment and prophylaxis of mania, bipolar disorder and recurrent depression. Aggressive or self-mutilating behaviour.

Tablets 10mg, 25mg, 50mg
Liquid 25mg/5mL

Sugar Free oral solution 50mg/5mL

Depression.

Consider overdose risk.

Capsules 10mg, 25mg, 50mg

Depressive illness, phobic and obsessional states.

MR tablets are considered by the Joint Formulary Committee for the BNF to be less suitable for prescribing.

Consider overdose risk.

Tablets 10mg, 25mg

Depressive illness.

Consider overdose risk.

Tablets 70mg
Liquid 70mg/5mL

Depression.

Less cardiotoxicity and lower risk in overdose compared with other tricyclic antidepressants.

Capsules 10mg, 25mg, 50mg

Depressive illness.

Consider overdose risk.

Tablets 10mg, 25mg

Depression.

Tablets 10mg, 25mg
Capsules 50mg

Tablets and Capsules

Capsules 50mg, 100mg
Tablets 150mg
Liquid 50mg/5mL - for titration/dose reduction and patients with swallowing difficulties.

At the 50mg and 100mg strengths capsules are significantly less expensive than tablets.

Depression, anxiety.

Consider overdose risk.

Tablets 15mg

Depression.

CAUTION: Many interactions with other medication, food and drink. Refer to SPC. Washouts required when changing to and from Phenelzine

Tablets 150mg, 300mg

Depression, social phobia.

Tablets (as hydrobromide) 10mg, 20mg
Oral drops (as hydrochloride) 40mg/mL (2mg/drop)

8mg oral drops is equivalent to 10mg tablet.

Lower incidence of drug interactions than some other SSRI’s.

First prescribe an SSRI in generic form unless there are interactions with other drugs; consider using citalopram or sertraline because they have less propensity for interactions.

Tablets 5mg, 10mg, 20mg

Generalised Anxiety Disorder,
Major depressive illness.

In depression, escitalopram is only licensed for major depressive episodes.

Available for consultant initiation in generalised anxiety disorder but only after sertraline has been tried.

Capsules 20mg,
Dispersible tablets 20mg (for patients unable to swallow standard capsules),
Liquid 20mg/5mL

First line for children and adolescents.
Higher propensity for drug interactions.

Tablets 20mg, 30mg

Higher risk of discontinuation reactions.
Higher propensity for drug interactions.

Tablets 50mg, 100mg

NICE advises: First prescribe an SSRI in generic form unless there are interactions with other drugs; consider using citalopram or sertraline because they have less propensity for interactions

LSCFT: Depressive illness, obsessive compulsive disorder (under specialist supervision in children), post traumatic stress disorder, panic disorder, social anxiety disorder. NICE recommend first line for generalised anxiety disorder (unlicensed).
Lower incidence of drug interactions than some other SSRI’s.

Tablets 5mg, 10mg, 20mg

Major depressive episodes.

Third line use one in line with NICE TA367.

Capsule 500mg

Hospital specialist initiation only for long term severe and disabling depressive illness, after trial of standard antidepressant treatment and as an adjunct to other antidepressant medication.

Tablets 25mg

Major Depressive Episodes.

with prior approval. LSCFT to approve all applications to use - patients currently on treatment can continue.

Capsules (Cymbalta®) 30mg, 60mg

There can be variation in the licensing of different medicines containing the same drug therefore prescribe by brand name.

Third line use within LSCFT.

CAUTION: available as another brand Yentreve for stress urinary incontinence. Recommended that prescriptions state the brand name Cymbalta.

Tablets 4mg

Not licensed in the elderly.

Tablets 37.5mg, 75mg
M/R capsules 75mg, 150mg

M/R capsules 225mg - to be prescribed as Vencarm XL in primary care
 
Immediate release tablets are first line.

Third line use only. Consider cardiovascular history e.g. uncontrolled hypertension, and risk of overdose.

Higher propensity for discontinuation.

Tablets 10mg, 30mg

Depressive illness.

Initiated by LSCFT only.

Due to risks of neutropenia and agranulocytosis a full blood count is recommended every 4 weeks.

Capsules 10mg, 18mg, 25mg, 40mg, 60mg

ADHD

 Restricted to initiation by child or adolescent psychiatrists or paediatricians
experienced in the management of ADHD.

Tablets 25 micrograms

ADHD (unlicensed indication).

Tablets 5mg, 10mg, 20mg

ADHD

M/R tablets 1mg, 2mg, 3mg, 4mg

For use in children and adolescents 6 - 17 years for whom stimulants are not suitable, not tolerated or have shown to be ineffective.

Specialist initiation only.

Adult Hard Capsules 30mg, 50 mg and 70mg (Elvanse Adult)

Hard capsules 20mg, 30mg, 40mg, 50mg, 60mg, 70mg (Elvanse)

Lisdexamfetamine (Elvanse) is recommended for use in the treatment of ADHD in children and young adults only in complex patients who meet both of the following criteria.
- extenuating circumstances exist which mean that a patient would not reliably receive all the required doses of dexamfetamine throughout the day and requires a once daily dose of lisdexamfetamine to support adherence
- treatment has been agreed through the internal governance arrangements of the trust.
  

Tablets 5mg, 10mg, 20mg
M/R tablets 18mg, 27mg, 36mg, 54mg
M/R capsules 5mg, 10mg, 20mg, 30mg, 40mg, 50mg, 60mg

All brands are formulary - choice of brand to made by specialist

For adult patients under the care of Psychiatry UK in South Cumbria, please prescribe as Xaggatin XL in primary care

Tablets 100mg

Specialist initiation only.

Tablets 75mg, 150mg

for NICE TA758:  Solriamfetol for excessive daytime sleepiness caused by narcolepsy

for NICE TA777: Solriamfetol for treating excessive daytime sleepiness caused by obstructive sleep apnoea 

6mg/ml solution for injection 3ml pre-filled pens 

liraglutide is recommended as an option in overweight and obesity as long as it is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service

 for NICE TA749 Liraglutide for managing obesity in people aged 12 to 17 years (terminated appraisal)

Solution for injection in pre filled pen

0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg

Only available via referral to a Tier 3 Weight Management Service.

 for NICE TA910 Semaglutide for managing overweight and obesity in young people aged 12 to 17 years.

Pre-filled pens, solution for injection.

Obesity.

Managing overweight and obesity in adults.

Treatment of post-chemotherapy nausea and vomiting (unlicensed indication).
For oncology use only.

Tablets 50mg
Injection 50mg/mL

Tablets 10mg, 25mg

Nausea and vertigo.

Tablets Doxylamine succinate 10 mg, Pyridoxine hydrochloride 10 mg.

Treatment of nausea and vomiting of pregnancy in women who do not respond to conservative management.

Injection 2.5mg/ml

For the prevention and treatment of post operative nausea and vomiting.
 Restricted use: Theatre use only, when other treatment options are not suitable.

Tablets 25mg
Tablets 6.25mg 
Injection 25mg/1mL

For palliative care use only.
Nausea and vomiting and agitation/terminal restlessness in the last days of life.

 for schizophrenia (new patients)

Tablets 5mg
Buccal tablets 3mg
Injection 12.5mg/1mL

Severe dystonic reactions sometimes occur with phenothiazines, especially in children and young people. Prochlorperazine should be avoided in patients with Parkinson’s disease and should be used cautiously in the elderly.

Tablets 10mg
Liquid 5mg/5ml
Injection 10mg/2mL

Metoclopramide can induce acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crises. These dystonic effects are more common in the young (especially girls and young women) and the very old.

Metoclopramide should only be prescribed for short-term use (up to 5 days).

Tablets 10mg
Liquid 5mg/5mL

Domperidone is no longer indicated for the relief of nausea and vomiting in children aged under 12 years or those weighing less than 35 kg.

Healthcare professionals are advised to adhere to the licensed dose and to use the lowest effective dose for the shortest possible duration (max. treatment duration should not usually exceed 1 week).

Tablets 4mg, 8mg
Liquid 4mg/5mL
Injection 4mg/2mL, 8mg/4mL

Nausea & vomiting post operatively or chemotherapy induced.

Tablets 1mg
Injection 1mg/1ml, 3mg/3ml

Nausea & vomiting post operatively or chemotherapy induced.
Second line 5HT3 anatagonist.

Second line for hyperemesis (unlicensed indication) in line with RCOG guidance.
Consultant initiation only.

Capsules 80mg, 125mg

Adjunct treatment to prevent nausea and vomiting associated with moderately and highly emetogenic chemotherapy.

Capsules 300 mg/0.5 mg

Prevention of acute and delayed nausea and vomiting associated with highly emetogenic cisplatin-based cancer chemotherapy.
Prevention of acute and delayed nausea and vomiting associated with moderately emetogenic cancer chemotherapy.
Oncology use only, only when aprepitant is ineffective.

Tablets 300micrograms
Patch 1mg/72hours

Tablets 30/500 (codeine 30mg/paracetamol 500mg),
tablets effervescent 30/500

Compound analgesic preparations (containing opioids) should not be used routinely. Patients should be given the individual components where possible to allow titration of dose. Where these preparations are used, they should be for short term use only, for relief of moderate pain.

Tablets 500mg
Dispersible tablets 500mg
Liquid 120mg/5mL, 250mg/5mL, 1g/10mL

Suppositories

Liquid and dispersible oral preparations reserved for when patients have with swallowing difficulties.

Consider OTC purchase

Some patients may be at increased risk of experiencing toxicity at therapeutic doses, particularly those with a body-weight under 50 kg and those with risk factors for hepatotoxicity. Clinical judgement should be used to adjust the dose of oral and intravenous paracetamol in these patients.

Intravenous infusion 1g/100mL

For short term treatment of moderate pain or fever when the oral route is not available.

Some patients may be at increased risk of experiencing toxicity at therapeutic doses, particularly those with a body-weight under 50 kg and those with risk factors for hepatotoxicity. Clinical judgement should be used to adjust the dose of oral and intravenous paracetamol in these patients.

Sublingual tablets 200micrograms

See section 4.10 for products used in opioid dependence.

Preparations that should be applied every 3 days (72 hours) include Hapoctasin®.

Preparations that should be applied every 4 days (96 hours) include Bupeaze®, Carlosafine®, Relevtec®, and Transtec®.

Preparations that should be applied every 7 days include Bunov®, Bupramyl®, Butec®, BuTrans®, Panitaz®, Rebrikel®, Reletrans®, and Sevodyne®.

Only for use in patients who are unable to take or tolerate oral medicine (including soluble tablets and liquids) OR where use of the low-dose buprenorphine patches may prevent administration problems for frail, elderly patients in the community.

Do not confuse the formulations of transdermal patches which are available in various strengths as 7-day, 4-day and 3-day patches; prescription by brand name is recommended.

Tablets 15mg, 30mg
Injection 60mg/1mL
Syrup 25mg/5mL
Linctus, BP 15mg/5mL

Injection 5mg, 10mg, 30mg, 100mg, 500mg

**under review**

Tablets 30mg

For short term use only.

 in MBHT For use only in patients who are breastfeeding or after initiation by the pain team.  For short term use only.

Matrix patches 12, 25, 50, 75, 100micrograms/hour for 72hours

Fentanyl matrix patches should be prescribed by brand name to minimise the risk of reservoir patches being accidentally supplied.

Tablets 200mg
Injection 100mg/1mL

MBHT use only: For those women who may need pain relief whilst they await transfer to either RLI or FGH.

Do not confuse modified-release 12-hourly preparations with 24-hourly preparations.

Modified-release tablets and capsules should be prescribed by brand.

Care should be taken to ensure that the correct strength of oral solution is prescribed and dispensed, and the dose stated as both quantity and volume.

Modified-release tablets
Immediate-release tablets
Immediate-release capsules
Oral solution

Refer to Trust guidance and protocols for specific prescribing information.

Do not confuse modified-release 12-hourly preparations with 24-hourly preparations.
Modified-release tablets and capsules should be prescribed by brand.

Injection 50mg/mL, 100mg/2mL

Capsules 50mg
Dispersible tablets 50mg
Modified-release tablets 100mg, 200mg

Do not confuse modified-release 12-hourly preparations with 24-hourly preparations, prescribers and dispensers must ensure that the correct formulation is prescribed and dispensed.

Modified-release formulations should be prescribed by brand.

Injection 100mg/2mL

M/R tablets 50mg, 100mg, 150mg, 200mg, 250mg

Chronic severe pain in adults.

Tablets 10mg, 25mg, 50mg
Liquid 25mg/5mL
Sugar Free oral solution 50mg/5mL

Use in line with NICE and LSCMMG guidelines.

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

Capsules 100mg, 400mg, 400mg

Liquid 50mg/5mL

 Unlicensed

Fo r chronic pain - Prescribing retained within NHS commissioned specialist pain services in Lancashire and South Cumbria.

 For palliative care only AMBER0 - under review

5% Medicated Plasters

Post Herpetic Neuralgia

 For off-label indications.

In UHMB, only indicated (off-label) use endorsed by UHMB acute pain team is for prescribing in rib fractures

Maximum of 4 weeks supply to be given on discharge and not to be continued in primary care.

If required for longer than 4 weeks then GP should refer to chronic pain team for review and not issue a prescription

Any other off label use must be on the advice of the acute pain team and must only be prescribed by secondary care.

For use in Palliative care/EoL settings discuss with the Palliative Care team.

Tablets 10mg, 25mg

Use in line with NICE and LSCMMG guidelines.

 Unlicensed indication.

Capsules 25mg, 50mg, 75mg, 100mg, 150mg, 200mg

Use in line with NICE and LSCMMG guidelines.

Tablets 100mg, 200mg, 400mg
Prolonged-release tablets 200mg, 400mg
Liquid 100mg/5mL

Tablets 50mg
Nasal spray 20mg/0.1mL actuation, 2 unit-dose spray device
Injection 6mg/0.5mL, 2 x 0.5mL prefilled syringes and auto-injector

Injection 3mg/0.5ml solution for injection in pre-filled pen

Orodispersable tablets 2.5mg

Zolmitriptan is recommended by NICE for predictable menstrual-related migraine that does not respond to standard acute treatment (unlicensed indication).

Tablets 10mg, 25mg, 50mg
Liquid 25mg/5mL
Sugar Free oral solution 50mg/5mL

Tablets 10mg, 60mg

Powder for solution for injection

 Specialist use only

Concentrate for solution for infusion 100mg/1mL

Pre-filled syringe 70mg, 140mg

Pre-filled pen 70mg, 140mg

Pre-filled pens/ pre-filled syringes 225mg/1.5ml solution for injection  

Solution for injection pre-filled pens  120mg/1ml

For NICE TA659: Galcanezumab for preventing migraine

Tablets 500micrograms, 1.5mg

Tablets 10mg, 40mg, 80mg
M/R capsules 80mg, 160mg

Prophylaxis of migraine.

Oral lyophilisate 75mg

 Prophylaxis of migraine (in patients who have at least 4 migraine days per month)

** North-West Pathway for Headache being developed **

Tablets 25mg, 50mg, 100mg, 200mg

Migraine Prophylaxis.

Capsules, 25mg. 50mg, 100mg

Approved for use in patients when prior prophylactic treatments have failed and erenumab, galcanezumab and fremanezumab are being considered.

 Unlicensed indication.

Capsules 5mg

Specialist consultant use only

Tablets 10mg, 25mg, 50mg, 75mg, 100mg
Oral solution 10mg/1ml

Adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation.

Oral solution 100mg/mL

Oral solution 2.2 mg/mL 

Tablets 100mg, 200mg, 400mg
M/R tablets 200mg, 400mg
Liquid 100mg/5mL
Suppositories 125mg, 250mg

Epilepsy.

Tablets 800mg

Adjunctive therapy in adults with partial onset seizures with or without secondary generalisation.

Tablets 150mg, 300mg, 600mg
Liquid 60mg/ml

Epilepsy.

Capsules 250mg
Liquid 250mg/5mL

Epilepsy.

Capsules 100mg, 300mg, 400mg

Epilepsy.

Capsules 25mg, 50mg, 75mg, 100mg, 150mg, 300mg

Epilepsy.

Tablets 50mg, 100mg, 150mg, 200mg
Oral solution 50mg/5ml

Epilepsy.

200mg/20ml solution for infusion - vials

Epilepsy.

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

Epilepsy.

Tablets 250mg, 500mg, 1g
Liquid 100mg/mL

Epilepsy.

Concentrate for solution for infusion 500mg/5ml

 Specialist use in palliative care.

Tablets

Partial-onset seizures with or without secondary generalised seizures.

Tablets 15mg, 30mg

Tablets 250mg

Capsules 25mg, 50mg, 100mg
Liquid 30mg/5mL

Prescribe by brand.

Tablets 100mg, 200mg, 400mg
Oral suspension 40mg/ml

Adjunct treatment of seizures in Lennox-Gastaut syndrome.

It should be used as a fourth line adjunctive therapy, usually in a combination with one or more of  the following medicines; sodium valproate (unlicensed), topiramate or lamotrigine. 

Tablets 5mg, 10mg, 15mg

Epilepsy.

Only to be considered in line with NICE as a third line add-on treatment option in people with focal seizures.

Tablets 25mg,50mg, 100mg, 200mg
Sprinkle capsules 15mg, 25mg, 50mg

Epilepsy.

Topiramate oral suspension - Restricted for paediatric use only, when sprinkle capsules are unsuitable. Prescribers should be cautious when selecting the strength of suspension as multiple strengths are available.

Crushable tablets 100mg
e/c tablets 200mg, 500mg
Liquid 200mg/5mL

Episenta® capsules (prolonged release sodium valproate) are also available for use, and are especially helpful for those patients with swallowing difficulties.
They are given once daily as capsules or sachets which can be opened and put on soft food if required, without chewing. Like other valproate preparations when used for epilepsy, they should be prescribed by brand name.

Injection 400mg with 4mL water for injections

400mg/4ml solution ampoules

Epilepsy.

Different preparations may vary in bioavailability and are therefore not interchangeable, prescriptions should include the brand name.

Tablets 500mg
Powder sachet 500mg

Epilepsy.

Capsules 25mg, 50mg, 100mg

Epilepsy.

Tablets 10mg

Tablets 12.5mg*, 25mg* (*initiation pack) 50mg, 100mg, 150mg, 200mg

Capsules 250mg, 500mg

Powder for oral suspension in sachet 250mg, 500mg

RED RAG (for all ages) for continuation of treatment of patients who have previously received the drug during childhood under the NHSE standard contract for paediatric neurosciences - neurology. Not to be newly initiated in adults

Injection 1mg/1mL with 1mL water for injections

Status epilepticus.

Injection (solution) 10mg/2mL
Injection (emulsion) (Diazemuls®)10mg/2mL

Rectal solution tube  5mg/2.5ml, 10mg/2.5ml

Status epilepticus.

Injection 4mg/1mL

Status epilepticus.

Oromucosal solution pre-filled oral syringes (Buccolam®) 2.5mg/0.5ml, 5mg/1ml, 7.5mg/1.5ml, 10mg/2ml

Buccal liquid (Epistatus ®) 10mg/1mL

Status epilepticus.

When an oral midazolam preparation is prescribed, a licensed product should be prescribed.

Buccal midazolam is available as both a 5mg/ml and 10mg/ml solution. To avoid confusion prescribe midazolam buccal solution using the brand name and state the dose in milligrams (mg) and millilitres (ml).

Rectal solution 50% in olive oil

Status epilepticus.

 Unlicensed

Injection 250mg/5mL

Status epilepticus.

Tablets 88micrograms, 180micrograms, 350 micrograms, 700micrograms pramipexole base (equivalent to 125micrograms, 250micrograms, 500micrograms and 1mg pramipexole salt)
Modified-release tablets 260 micrograms, 520 micrograms 1.05mg, 1.57mg, 2.1mg, 2.62mg, 3.15mg base (equivalent to 375micrograms, 750micrograms, 1.5mg, 2.25mg, 3mg, 3.75mg, 4.5mg salt)

Parkinson's disease.

Tablets 88micrograms, 180micrograms, 350 micrograms, 700micrograms pramipexole base (equivalent to 125micrograms, 250micrograms, 500micrograms and 1mg pramipexole salt)

Restless leg syndrome.

Recommended as the first line pharmacological treatment for restless leg syndrome, in line with the LSCMMG Restless Legs Syndrome Guidance.

Tablets 250micrograms, 500micrograms, 1mg, 2mg
Modified-release tablets 2mg, 3mg, 4mg, 6mg, 8mg

Parkinson's disease.

Tablets 250micrograms, 500micrograms, 1mg, 2mg

Restless leg syndrome.

Recommended as the second line pharmacological treatment for restless leg syndrome, in line with the LSCMMG Restless Legs Syndrome Guidance.

Patches 2mg/24 hours, 4mg/24 hours, 6mg/24 hours, 8mg/24 hours

Parkinson's Disease.

Rotigotine has shown inferiority to ropinirole and should not be used in preference to other dopamine agonists unless such alternative are not suitable (e.g. compliance issues, need for social care to administer other oral therapies, dysphagia), not tolerated (GI disturbance), or ineffective.

Patches 1mg/24 hours, 2mg/24 hours, 3mg/24 hours

Restless Legs Syndrome.

Recommended for restricted use in line with the LSCMMG Restless Legs Syndrome Guidance.

Injection 50mg/5mL

Pre-filled pen 30mg/3mL

Capsules 100mg
Liquid 50mg/5mL

Parkinson's disease (but not drug-induced extrapyramidal symptoms).

Capsules 62.5mg (12.5/50), 125mg (25/100), 250mg (50/200)
Dispersible tablets 62.5mg (12.5/50), 125mg(25/100)
Modified-release capsules 125mg (25/100)

Parkinson's disease.

Tablets 62.5mg (12.5/50), 110mg (10/100), 125mg (25/100), 275mg (25/250)
Modified-release tablets 125mg (25/100), 250mg (50/200)

Parkinson's disease.

Tablets (multiple strength combinations available).

Parkinson's disease.

Solution for infusion 240mg/ml + 12mg/ml

Parkinson's disease.

Tablets 1mg

Parkinson's disease.

Tablets 5mg, 10mg

Parkinson's disease.

See BNF for information on dose equivalence and conversion between tablet and lyophilisate formulations.

Tablets 200mg

Adjunct to co-beneldopa or co-careldopa in Parkinson's disease.

Capsules 50mg

Adjunctive therapy in adults with end-of-dose motor fluctuations who cannot be stabilised on preparations of levodopa/DOPA decarboxylase inhibitors.

Tablets 100mg

Tolcapone as an adjunct to co-beneldopa or co-careldopa in Parkinson's disease with 'end-of-dose' motor fluctuations if another inhibitor of peripheral catechol-O-methyltransferase is inappropriate.

Third Line.

Liquid 50mg/5mL

Tablets 2mg, 5mg
Liquid 5mg/5mL

Tablets 800mg, 1200mg

See section 2.4

Tablets 50mg

Suspension 5mg/1ml

Amyotrophic Lateral Sclerosis form of Motor Neurone Disease.

Consultant neurologist initiation only.

Tablets 25mg

Injection 100units

For existing patients

Consultant use only

Brands are not interchangeable

Focal Spasticity in Multiple Sclerosis, Contracture of the joint in Multiple Sclerosis.  Focal spasticity, Hand and wrist disability associated with stroke, Blepharospasm, Hemifacial spasm, Spasmodic torticollis.