| Formulary Chapter 4: Central nervous system - Full Chapter
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| 04.02.01 |
Antipsychotic Drugs |
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| 04.02.01 |
First-Generation Antipsychotic Drugs |
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| 04.02.01 |
Second-Generation Antipsychotic Drugs |
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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.
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Amisulpride
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Formulary
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Tablets 50mg, 100mg, 200mg, 400mg
Liquid 100mg/mL
Schizophrenia.
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 LSCMMG: Shared care guideline
 MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
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Aripiprazole (Abilify®)
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Formulary
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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)
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LSCMMG: Shared care guideline
MHRA: Aripiprazole (Abilify and generic brands): risk of pathological gambling
MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 to 17 years
NICE TA292: Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder
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Cariprazine (Reagila®)
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Formulary
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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.
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 LSCFT - Cariprazine medicine request form
LSCMMG: Shared care guideline
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Clozapine
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Formulary
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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.
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LSCFT - Clozapine injection medication request form
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Lurasidone (Latuda®)
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Formulary
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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
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LSCFT - Lurasidone medicine request form
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Olanzapine
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Formulary
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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.
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LSCMMG: Shared care guideline
MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
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Quetiapine
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Formulary
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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.
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LSCFT - Quetiapine XL medicine request form
LSCMMG: Shared care guideline
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Risperidone
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Formulary
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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.
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LSCMMG: Shared care guideline
MHRA: Recent drug-name confusion
MHRA: Risperidone and paliperidone: risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery
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Olanzapine Depot Injection
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Formulary
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Schizophrenia.
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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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