| Formulary Chapter 4: Central nervous system - Full Chapter
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| 04.02.02 |
Antipsychotic depot injections |
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Aripiprazole (Abilify Maintena®)
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Formulary
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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.
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 LSCFT - Aripiprazole depot injection medicine request form
 MHRA: Aripiprazole (Abilify and generic brands): risk of pathological gambling
MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
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Flupentixol Decanoate
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Formulary
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Injection 20mg/1mL, 40mg/2mL
Concentrate injection 50mg/0.5mL, 100mg/1mL
Maintenance in schizophrenia and other psychoses.
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Fluphenazine
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Formulary
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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.
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Haloperidol decanoate injection
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Formulary
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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.
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MHRA: Haloperidol (Haldol): reminder of risks when used in elderly patients for the acute treatment of delirium
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Paliperidone
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Formulary
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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.
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LSCFT - Paliperidone depot injection medicine request form
LSCMMG: Paliperidone palmitate prolonged release suspension for injection
LSCMMG: Paliperidone palmitate prolonged release suspension for injection (six monthly)
MHRA: Risperidone and paliperidone: risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery
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Pipotiazine Palmitate
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Formulary
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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.
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Risperidone (Risperdal Consta®)
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Formulary
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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.
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MHRA: Clozapine and other antipsychotics: monitoring blood concentrations for toxicity
MHRA: Recent drug-name confusion
MHRA: Risperidone and paliperidone: risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery
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Zuclopenthixol Decanoate
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Formulary
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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.
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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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