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 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:

This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net

For more information about the formulary development process, please see: https://www.lancsmmg.nhs.uk/lancashire-and-south-cumbria-icb-formulary-development/

 Details...
04.02.01  Expand sub section  Antipsychotic Drugs
04.02.01  Expand sub section  First-Generation Antipsychotic Drugs
04.02.01  Expand sub section  Second-Generation Antipsychotic Drugs
 note 

CSM advice: Second-generation (atypical) antipsychotics and increased risk of stroke–see BNF

 

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

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

 
Link  LSCMMG: Shared care guideline
 
Aripiprazole (Abilify®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 1

Tablets 5mg,10mg,15mg, 30mg
Dispersible tablets 10mg,15mg
Liquid 1mg/mL

Consultant psychiatrist initiation only

 
Link  LSCMMG: Shared care guideline
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
 
CariprazineBlack Triangle (Reagila®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 1

Tablets 1.5mg, 3mg, 4.5mg, 6mg

 
Link  LSCFT - Cariprazine medicine request form
Link  LSCMMG: Shared care guideline
 
Clozapine
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection

LSCFT use only

unlicensed 

 
Link  LSCFT - Clozapine injection medication request form
 
Clozapine (Clozaril®)
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Formulary
Red
Tablets 25mg, 100mg

Consultant psychiatrist initiation only

Patients must be registered with the Clozapine Patient Monitoring Service (CPMS) 
Link  MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
Link  MHRA: Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
 
Clozapine (Denzapine®)
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Formulary
Red
Liquid 100mg/5mL

Consultant psychiatrist initiation only

Patients must be registered with the Denzapine Patient Monitoring Service 
Link  MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
Link  MHRA: Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
 
LurasidoneBlack Triangle (Latuda®)
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Formulary
Red

Tablets 18.5mg, 37mg, 74mg

LSCFT initiated only

 
Link  LSCFT - Lurasidone medicine request form
 
Olanzapine
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 10mg/2mL

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

Tablets 2.5mg, 5mg, 7.5mg, 10mg, 15mg
Dispersible tablets (Velotabs®) 5mg, 10mg, 15mg, 20mg

 
Link  LSCMMG: Shared care guideline
 
Quetiapine
View adult BNF View SPC online View childrens BNF
Formulary
Amber 1

Tablets 25mg, 100mg, 150mg, 200mg, 300mg


M/R tablets 50mg, 200mg, 300mg, 400mg (to be prescribed as Sondate XL in primary care)

LSCFT initiated only

 
Link  LSCFT - Quetiapine XL medicine request form
Link  LSCMMG: Shared care guideline
 
Risperidone
View adult BNF View SPC online View childrens BNF
Formulary
Amber 1

Tablets 500micrograms, 1mg, 2mg, 3mg
Dispersible tablets (Quicklets®) 1mg, 2mg
Liquid 1mg/mL

 
Link  LSCMMG: Shared care guideline
 
 ....
Key
Restricted Drug Restricted Drug
Unlicensed Drug Unlicensed
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
ICB
ICB
Green Low Carbon

Low carbon footprint

Amber Medium Carbon

Medium carbon footprint

Red High carbon footprint

High carbon footprint

Status Description

Green

Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.  

Green Restricted

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.   

Red

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.  

Amber 0

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.  

Amber 1

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.  

Amber 2

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).  

Do Not Prescribe

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.  

Grey

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.   

Multiple

Refer to local guidance and local commissioning arrangements  

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