| Formulary Chapter 4: Central nervous system - Full Chapter
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| 04.04 |
CNS stimulants and other drugs used for attention deficit hyperactivity disorder |
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Atomoxetine
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Formulary
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Capsules 10mg, 18mg, 25mg, 40mg, 60mg
ADHD
 Restricted to initiation by child or adolescent psychiatrists or paediatricians
experienced in the management of ADHD.
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 LSCMMG: Shared care guideline
MHRA: Atomoxetine (Strattera▼): increases in blood pressure and heart rate
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Clonidine hydrochloride
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Formulary
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Tablets 25 micrograms
ADHD  (unlicensed indication).
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Dexamfetamine
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Formulary
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Tablets 5mg, 10mg, 20mg
ADHD
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LSCMMG: Shared care guideline
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Guanfacine (Intuniv®)
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Formulary
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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.
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LSCMMG: Shared care guideline
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Lisdexamfetamine (Elvanse®)
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Formulary
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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.
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LSCMMG: Shared care guideline
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Methylphenidate
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Formulary
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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.
Certain methylphenidate products are in limited supply and may be out of stock due to on-going supply disruption; prescribe generically to enable switching between bioequivalent MR products where possible to do so.
For adult patients under the care of Psychiatry UK in South Cumbria, please prescribe as Xaggatin XL in primary care.
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LSCMMG: Shared care guideline
MHRA: Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations
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Modafinil
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Formulary
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Tablets 100mg
Specialist initiation only.
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MHRA: Modafinil (Provigil): increased risk of congenital malformations if used during pregnancy
MHRA: Modafinil (Provigil): now restricted to narcolepsy
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Solriamfetol hydrochloride (Sunosi®)
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Formulary
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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
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NICE TA758: Solriamfetol for treating excessive daytime sleepiness caused by narcolepsy
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| 04.04 |
Cocaine |
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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Traffic Light Status Information
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Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance. |
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