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