4: Central Nervous System

Transcription

1 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 1 of 25 4: entral Nervous System 4.1 Hypnotics and anxiolytics Hypnotics Temazepam SF Solution (10mg/5ml) Temazepam Tablets (10mg) Zolpidem Tablets (5mg) Zopiclone Tablets (3.75mg, 7.5mg) omments SM advice: 1. Benzodioazepines are indicated for the short term relief (two to four weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress occurring alone or in association with insomnia or short term psychosomatic, organic or psychotic illness. 2. The use of benzodiazepines to treat short term mild anxiety is inappropriate and unsuitable 3. Benzodiazepines should be used to treat insomnia only when it is severe, disabling or subjecting the individual to extreme distress Non benzodiazepine hypnotics that act at the benzodiazepine receptor. Licensed for short term treatment of insomnia Formulary Nitrazepam Suspension (2.5mg/5ml) Nitrazepam Tablets (5mg) hloral Hydrate Solution (500mg/5ml) Anxiolytics estricted to existing patients who come into hospital on it. See SM advise above For inpatient use only. Any outpatient prescriptions or discharges should be checked with the paediatric pharmacist and discussions should include whether chrloal hydrate mg/5ml (Welldorm) could be used instead as this is much more economical in the community.

2 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 2 of 25 hlordiazepoxide apsules (5mg, 10mg Diazepam Solution (2mg/5ml, 5mg/5ml) Diazepam Tablets (2mg, 5mg, 10mg) Lorazepam Injection (4mg/1ml) Lorazepam Tablets (1mg, 2.5mg) Oxazepam Tablets (10mg, 15mg) Formulary Buspirone 5mg Tablets onsultant Psychiatrist use only for short term treatment of anxiety 4.2 Drugs used in psychoses and related disorders Antipsychotic drugs hlorpromazine Syrup (25mg/5ml) hlorpromazine Injection (50mg/2ml) hlorpromazine Tablets (10mg, 25mg, 50mg, 100mg) hlorpromazine Suppositories (100mg) hlorpromazine Suspension (100mg/5ml) Flupentixol Tablets (3mg) Fluphenazine Tablets (1mg, 2.5mg) Haloperidol Injection (5mg/1ml) Haloperidol apsules (500micrograms) Haloperidol Tablets (1.5mg, 5mg) Haloperidol SF Solution (5mg/5ml) Levomepromazine Tablets (25mg) Promazine Tablets (25mg) Promazine Syrup (25mg/5ml) Sulpiride SF Solution (200mg/5ml) Sulpiride Tablets (200mg, 400mg) Trifluoperazine M capsules (2mg, 10mg,15mg) Trifluoperazine Tablets (1mg, 5mg) Trifluoperazine Syrup (1mg/5ml) Trifluoperazine Solution (5mg/5ml) Zuclopenthixol Tablets (2mg, 10mg, 25mg) Zuclopenthixol Injection (50mg/1ml, 100mg/2ml) Formulary

3 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 3 of 25 Benperidol Tablets (250micrograms) Benperidol is used in treatment of deviant antisocial behavious but its value is not established. To be prescribed by onsultant Psychiatrists only Pimozide Tablets (4mg) eserved for existing patients only

4 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 4 of 25 Atypical antipsychotics Formulary Amisulpride Tablets (50mg, For onsultant Psychiatrist use only 200mg, 100mg) Amisulpride 500mg/5ml Solution For onsultant Psychiatrist use only Aripiprazole Tablets (5mg, For onsultant Psychiatrist use only. 10mg, 15mg, 30mg) lozapine Tablets (25mg, 100mg) lozapine Liquid (100mg/5ml) For onsultant Psychiatrist use only. egistration needed for all patients on this drug. Levomepromazine Tablets (25mg) Levomepromazine Injection (25mg/ml) Olanzapine Tablets (2.5mg, 5mg, 7.5mg, 10mg, 15mg) Olanzapine Orodispersible Tablets (5mg, 10mg, 15mg, 20mg) For onsultant Psychiatrist use and for palliative care For onsultant Psychiatrist use only For onsultant Psychiatrist use only For use only in patients with swallowing difficulites Olanzapine Injection (10mg) For onsultant Psychiatrist use only Quetiapine Starter Pack Quetiapine Tablets (25mg, 50mg, 100mg, 150mg, 200mg, 300mg) Quetiapine M Tablets (200mg, 300mg) For onsultant Psychiatrist use only Quetiapine M tablets are much more expensive than the immediate release tablets isperidone Liquid (5mg/5ml) For onsultant Psychiatrist use only isperidone Tablets (500micrograms, 1mg, 2mg, 3mg) For onsultant Psychiatrist use only isperidone Orodispersible Tablets (500micrograms, 1mg, 2mg, 3mg) isperidone Injection (25mg, 37.5mg, 50mg) Antipsychotic depot injections For onsultant Psychiatrist use only For use only in patients with swallowing difficulites For onsultant Psychiatrist use only Flupentixol Decanoate Injection (20mg/1ml, 40mg/2ml, 50mg/0.5ml, 100mg/1ml, 200mg/1ml)

5 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 5 of 25 Fluphenazine Decanoate Injection (100mg /1ml, 50mg/2ml, 25mg/ml, 50mg/0.5ml, 12.5mg/0.5ml) Haloperidol Decanoate Injection (100mg/1ml, 50mg/1ml) Pipotiazine Injection (50mg/1ml, 100mg/2ml) Zuclopenthixol Injection (200mg/1ml, 500mg/1ml) Antimanic drugs First line Others Lithium arbonate M/ Tablets (200mg, 400mg) PIADEL Lithium itrate syrup 509mg (5.4mmol) in 5ml PIADEL Lithium arbonate M/ Tablets (250mg,400mg) AMOLIT omments Lithium carbonate 200mg = lithium citrate 509mg eserved for patients who come in on it Formulary Valproic acid as Semi Sodium Valproate Tablets (250mg, 500mg) Depakote For onsultant Psychiatrist use only for the treatment of manic episodes associated with bipolar depression Should be prescribed by brand 4.3 Antidepressant drugs Tricyclic and related antidepressant drugs Tricyclic and related antidepressants should be used with caution in patients with cardiovascular disease because of the risk of arrhythmias, patient with concomitant condtions such as hyperthyroidism and phaeochromocytoma should be treated witrh care. are is also needed in patient with epilepsy and diabetes. lomipramine apsules (10mg, 25mg, 50mg) lomipramine M Tablets (75mg) lomipramine Injection (25mg/2ml) Dosulepin apsules (25mg) Doxepin apsules (25mg, 50mg) Imipramine Tablets (10mg, 25mg) Lofepramine Tablets (70mg) Lofepramine SF Suspension (70mg/5ml) Nortriptyline Tablets (10mg, 25mg)

6 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 6 of 25 Trazodone Tablets (150mg) Trazodone apsules (50mg, 100mg) Trazodone SF Liquid (50mg/5ml) Trimipramine Tablets (10mg, 25mg)

7 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 7 of 25 Formulary Amitriptyline SF Solution (25mg/5ml) Amitriptyline Tablets (10mg, 25mg, 50mg) Dosulepin Oral Solution (25mg/5ml, 75mg/5ml) Dosulepin Tablets (75mg) Mianserin Tablets (10mg, 20mg, 30mg) eserved for patient who are admitted on them. Amitriptyline is not routinely recommended as as antidepressant but may be considered for neuropathic pain eserved for patient who are admitted on them eserved for existing patients only Monoamine-oxidase inhibitors Moclobemide Tablets (150mg, 300mg) Phenelzine Tablets (15mg) Selective serotonin re-uptake inhibitors First line italopram Oral Drops (40mg/1ml) italopram Tablets (10mg, 20mg, 40mg) omments 4 oral drops (8mg) is equivalent to a 10mg tablet Please express the dose on the oral drops as drops rather than milligrams. MHA advice italopram and escitalopram are associated with dose dependent QT interval prolongation and should not be used in those with: congenital long QT syndrome; known pre-existing QT interval prolongation; or in combination with other medicines that prolong the QT interval. EG measurements should be considered for patients with cardiac disease, and electrolyte disturbances should be corrected before treatment. For citalopram, new restrictions on the maximum daily dose apply: 40mg for adults; 20mg for patoient over 65years;

8 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 8 of 25 and 20mg for those with hepatic impairment. Fluoxetine apsules (20mg) Fluoxetine Liquid (20mg/5ml) Second line Paroxetine Tablets (10mg, 20mg, 30mg) Paroxetine SF Liquid (10mg/5ml) Sertraline Tablets (50mg, 100mg) Formulary Escitalopram Tablets (10mg, 20mg) onsultant Psychiatrist use only Escitalopram Oral Solution (10mg/ml) MHA advice italopram and escitalopram are associated with dose dependent QT interval prolongation and should not be used in those with: congenital long QT syndrome; known pre-existing QT interval prolongation; or in combination with other medicines that prolong the QT interval. EG measurements should be considered for patients with cardiac disease, and electrolyte disturbances should be corrected before treatment. For escitalopram, the maximum daily dose for patients older than 65 years in now reduced to 10mg/day; other doses remain unchanged Other antidepressant drugs Flupentixol Tablets (500micrograms, 1mg) Formulary Duloxetine apsules (30mg, 60mg) onsultant Psychiatrist use only ymbalta brand only Mirtazapine Orodispersible Tablets onsultant Psychiatrist use only (15mg, 30mg, 45mg) eboxetine Tablets (4mg) onsultant Psychiatrist use only Venlafaxine Tablets (37.5mg, 75mg) onsultant Psychiatrist use only

9 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 9 of 25 Venlafaxine M/ apsules (75mg, 150mg) onsultant Psychiatrist use only For use in patients who have already been stabilised on venlafaxine immediate release tablets 4.4 NS stimulants and other drugs used for attention deficit hyperactivity disorder affeine itrate Solution (50mg/5ml) Formulary Methylphenidate Tablets 10mg Methylphenidate Tablets M 20mg onsultant Psychiatrist and Paediatrician use only Modafinil Tablets (100mg) estricted to espiratory onsultant use only for the treatment of excessive daytime sleepiness associated with narcolepsy 4.5 Drugs used in the treatment of obesity NIL Anti-obesity drugs acting on the gastrointestinal tract Formulary Orlistat apsules (120mg) Available for patients who come in on it who are being treated according to NIE G entrally acting appetite suppressants

10 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 10 of Drugs used in nausea and vertigo Link to: Nausea and Vomiting (Postoperative) Management Guideline First line Dexamethasone tabolets 8mg omments Second line Third line Ondansetron tablets (4mg) Ondansetron injection (4mg in 2ml) Ondansetron syrup (4mg in 5ml) Prochlorperazine Injection (12.5mg/1ml) Prochlorperazine Tablets (5mg) Prochlorperazine Buccal Tablets 3mg Prochlorperazine Syrup (5mg/5ml) yclizine Tablets (50mg) yclizine Injection (50mg/ml) yclizine Liquid (25mg/5ml) Metoclopramide Syrup (5mg/5ml) Metoclopramide Injection (10mg/2ml) Metoclopramide Tablets (10mg) Domperidone SF Suspension (5mg/5ml) Domperidone Suppositories (30mg) Domperidone Tablets (10mg) Droperidol injection 2.5mg/ml For use within its licensed indication in accordance with protocol. yclizine is an antihistamine. Dose should be reduced in elderly as it can cause drowsiness Least effective antiemetic but it can relieve full feeling in stomach Extra pyramidal side effects e.g. tremor/dystonia and abnormal eye movements can be reversed with 5-10 mg procyclidine given IM or IV (2.5mg-5mg in elderly) May be administered rectally. Less likely to give rise to sedation and abnormal facial and eye movements onsultant Anaesthetist use only for the prevention and treatment of PONV in adult patients in whom other IV antiemetics are ineffective or contraindicated.

11 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 11 of 25 Formulary Aprepitant 3 day pack apsules (80mg+125mg) Ondansetron Tablet (8mg) Ondansetron Injection (8mg/4ml) Dexamethasone sodium phosphate injection 8mg in 2ml Dexamethasone tablets 2mg Levomepromazine Injection Use supported for during 2 nd and subsequent cycles of cisplatin-based chemotherapy for patients who have had intractable N&V during 1 st cycle despite having 5HT3 antagonist. Prescribed by onsultant Haematologist and Oncologist for prevention of nausea and vomiting induced by highly emetogenic chemotherapy For palliative care use only 25mg/ml Levomepromazine Tablets 25mg For palliative care use and for onsultant Psychiatrist use only Motion sickness Betahistine Tablets (8mg) innarizine Tabets (15mg) Hyoscine hydrobromide (Kwells Tablets) Promethazine theoclate Tablets (25mg) Formulary Hyoscine hydrobromide Patch (1.5mg) (1mg in 72hrs) Hyoscine hydrobromide injection 400micrograms / ml Glycopyrronium bromide tablets (1mg ) eserved for prevention of excessive salivation and reduction of secretions See BNF For use by ommunity Paediatricians. eserved for prevention of excessive salivation and reduction of secretions in patients who cannot tolerate or who do not respond to hyoscine patches. Unlicensed product paperwork required

12 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 12 of Analgesics (Needs to link to pain ladder) Link to Musculoskeletal section for NSAID s Non-opioid analgesics First line Paracetamol aplets (500mg) Paracetamol Tablets (500mg) Paracetamol Suspension (120mg/5ml, 250mg/5ml) Paracetamol Suppositories (60mg, 120mg, 240mg, 500mg) Paracetamol Tablet Soluble (500mg) omments Link to analgesic table Formulary Paracetamol Infusion (1g/100ml) eserved for use in adults, adolescents and children weighing more than 33kg: 1. who have undergone bowel surgery 2. with moderate pain who are unable to take oral analgesia, who already have an IV running and where rectal paracetamol is inappropriate. Paracetamol Infusion (500mg/50ml) eserved for use in term newborn infants, infants, toddlers and children weighing less than 33kg: 1. who have undergone bowel surgery 2. with moderate pain who are unable to take oral analgesia, who already have an IV running and where rectal paracetamol is inappropriate. Nefopam Tablets (30mg) For psychiatric wards only Aspirin Tablets Dispersible (300mg) Aspirin Tablets E (300mg) Aspirin Suppositories (150mg, 300mg)

13 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 13 of Opioid analgesics ompound analgesics ompound analgesic preparations containing paracetamol with a low does of opioid analgesic are commonly used but their advantages have not been substantiated. The low dose of opioid may be enough to cause opioid side effectcs (particularly constipation) and can complicate the treatment of overdoasge yet may not provide significant additional relief of pain. First line o-dydramol 10/500 Tablets (paracetamol 500mg with dihydrocodeine 10mg) o-codamol 8/500 Tablets (paracetamol 500mg, codeine phosphate 8mg) o-codamol 8/500 Effervescent Tablets (paracetamol 500mg, codeine phosphate 8mg) Stronger opioids o-codamol Tablets 30/500 (paracetamol 500mg, codeine phosphate 30mg) odeine Phosphate Tablets (15mg, 30mg, 60mg) odeine Phosphate Injection (60mg/ml) odeine Phosphate Syrup (25mg/5ml) Dihydrocodeine Solution (10mg/5ml) Dihydrocodeine Tablets (30mg) Dihydrocodeine Injection (50mg/1ml) Morphine Sulphate M Tablets (5mg, 10mg, 15mg, 30mg, 60mg, 100mg, 200mg) Morphine Sulphate oral Solution (10mg/5ml, 100mg/5ml) Morphine Sulphate Injection (10mg/1ml, 1mg/ml) Morphine Sulphate Intrathecal Injection (2mg/2ml) Morphine Syringes 50mg/50ml Morphine Injection (50mg/50ml) Morphine Sulphate M Sachets (20mg, 30mg) Tramadol apsules 50mg omments Please use the analgesic ladder as a guide to the treatment of pain. Try to avoid the use of these products as they are not included on the analgesic ladder. Link to analgesic ladder Please ensure that the brand of sustained release morphine is stated on the discharge letter to GP s

14 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 14 of 25 Buprenorphine patches 5mcg/hr BuTrans 10mcg/hr BuTrans 20mcg/hr BuTrans 35mcg/hr Transtec 52.5mcg/hr Transtec 70mcg/hr - Transtec Not to be used in opioid naïve patients. For elderly patients requiring chronic pain relief who are unable to take oral opioid medication or who are non-compliant with syringe drivers. For selected oncology patients. For the BuTrans products, the release is over a 7 day period. For the Transtec products, the release is over a 4 day period. Formulary Alfentanil Injection 1mg/2ml For theatre and IU use only. Alfentanil Injection 5mg/10ml Alfentanil Nasal Spray For Palliative are onsultant s use only 5mg/5ml Alfentanil Injection 5mg/1ml For Palliative are onsultant s use only and IU Buprenorphine Sublingual Tablets (200micrograms, 400micrograms, 2mg, 8mg) Buprenorphine Injection (300mcg/ml) S Diamorphine Injection 5mg Use restricted to: A&E (intranasal use only in children), Labour ward (obstetric use), Theatre & ecovery - For IT/ IV/ epidural use, mainly for obstetric cases, Palliative care (only for patient who have come in and are established on diamorphine - used routinely at Harden ward BH (North Yorkshire PT) for S Diamorphine Injection (10mg, 30mg, 100mg, 500mg) palliative care syringes, initiated by GPs) For aseptic use only for preparation of diamorphine syringes

15 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 15 of 25 Formulary S Dihydrocodeine M/ Tablets (60mg, 90mg, 120mg) Fentanyl Patches (12micrograms, 25micrograms, 50micrograms, 75micrograms, 100micrograms) Fentanyl (Abstral) Sublingual Tablets (S/L) (100mcg, 200mcg, 300mcg, 400mcg) Hydromorphone apsules (1.3mg, 2.6mg) Hydromorphone M/ apsules (2mg, 4mg, 8mg, 16mg, 24mg) Hydromorphone Injection (10mg/1ml, 50mg/1ml) Morphine Sulphate Injection (15mg/1ml,30mg/1ml, 60mg/10ml) Oxycodone Hydrochloride Injection (20mg/2ml, 10mg/1ml) Oxycodone capsules (5mg, 10mg, 20mg) Oxycodone m/r tablets (5mg, 10mg, 20mg, 40mg, 80mg) Oxcodone Liquid (50mg/5ml) Oxcodone SF Liquid (5mg/5ml) Pethidine Injection (100mg/2ml, 50mg/1ml) Papaveretum Injection 15.4mg/ml Papaveretum Injection 7.7mg/ml For use in chronic pain states only Palliative care use or under recommendation by the pain team Please ensure that the brand prescribed is written on the dischsarge prescription Not to be used in opioid naïve patients. For the treatment of breakthrough cancer pain in patients in whom standard treatments (morphine or oxycodone) are ineffective or not tolerated Under Palliative are onsultant s recommendations for patients intolerant of morphine Under Palliative are onsultant s recommendations for patients intolerant of morphine Under Palliative are onsultant s recommendations for patients intolerant of morphine Aseptics use only For Palliative are use only or For use by Palliative are onsultants Second-line after morphine for patients developing intolerable side effects with morphine eserved for obstetric use only Unsuitable for women of childbearing age Syrup BP (66.7%) 50ml For neonatal use only

16 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 16 of 25 Formulary Tramadol M Tablets (100mg) Tramadol Soluble Tablets (50mg) Tramadol M apsules (50mg) Tramadol Injection (100mg/2ml) Tramadol can be used as an alternative to dihydrocodeine or codeine in patient with uncontrolled acute or chronic pain or where side effects of codeine/dihydrocodeine are a problem. The sustained release preparations should not be used for acute pain.

17 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 17 of Neuropathic and functional pain efer to BNF for products. NIE linical Guideline G96 Neuropathic pain pharmacological management Gabapentin apsules (100mg, 300mg, 400mg) Formulary Pregabalin apsules (25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 300mg) For use by Diabetic team for the treatment of diabetic neuropathy (as an alternative to gabapentin and following a trial of a tricyclic drug). For the treatment of neuropathic back pain in patients in whom gabapentin and tricyclics have been ineffective or not tolerated Antimigraine drugs Treatment of the acute migraine attack Treatment of a migraine attack should be guided by response to previous treatment and the severity of the attacks. A simple analgesic such as aspirin, paracetamol (preferably in a soluble or dispersible form) or an NSAID is often effective; concomitant antiemetic treatment may be required. If treatment with an analgesic is inadequate, an attack may be treated with a specific antimigraine compound such as a 5HT 1 agonist (triptan) Analgesics Aspirin see Section Paracetamol see Section Non Steroidal Antiinflammatory Drugs see Section HT 1 agonists Sumatriptan Tablets (50mg, 100mg) Sumatriptan Nasal Spray (10mg/0.1ml, 20mg/0.1ml) Sumatriptan Syringe plus autoinjectors (6mg/0.5ml) Sumatriptan Syringe efill (6mg/0.5ml)

18 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 18 of Prophylaxis of migraine Pizotifen Tablets (500micrograms, 1.5mg) Pizotifen Elixir (250micrograms/5ml) See BNF for other treatments 4.8 Antiepileptics ontrol of epilepsy Antiepileptics should be prescribed by brand arbamazepine SF Liquid (100mg/5ml) arbamazepine chewable Tablets (100mg, 200mg) arbamazepine Tablets (100mg, 200mg) arbamazepine M Tablets (200mg, 400mg) arbamazepine Suppositories (125mg, 250mg) lobazam Tablets (10mg) lonazepam SF Solution (500micrograms/5ml) lonazepam Tablets (500micrograms, 2mg) lonazepam injection 1mg/1ml Ethosuximide apsules (250mg) Ethosuximide Syrup (250mg/5ml) Lamotrigine Tablets (25mg, 50mg, 100mg, 250mg) Lamotrigine Dispersible Tablets (5mg, 25mg, 100mg) Lamotrigine (Lamictal) ewable/ Dispersible Tablets (2mg) Levetiracetam Tablets (250mg, 500mg, 1000mg) Levetiracetam Oral Solution (100mg/ml) Levetiracetam Infusion (100mg/ml) Phenobarbital Tablets (15mg, 30mg, 60mg) Phenobarbital Injection (60mg/1ml, 200mg/ml) Phenobarbital Mixture (15mg/5ml, 50mg/5ml) Phenytoin Injection (250mg/5ml) Phenytoin Suspension (30mg in 5ml) Phenytoin Sodium Injection (250mg/5ml) Phenytoin Sodium apsules (25mg, 50mg, 100mg) Phenytoin Sodium Tablets (50mg, 100mg) Primidone Tablets (250mg) Sodium Valproate (Epilim) SF Liquid (200mg/5ml) Sodium Valproate (Orlept) SF Liquid (200mg/5ml) Sodium Valproate (Epilim) Injection (400mg) Sodium Valproate (Episenta) Injection (300mg/3ml)

19 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 19 of 25 Sodium Valproate (Epilim) E Tablets (200mg, 500mg) Sodium Valproate (Orlept) E Tablets (500mg) Sodium Valproate (Epilim hrono) M Tablets (200mg, 300mg, 500mg) Sodium Valproate (Episenta) M apsules (150mg, 300mg) Sodium Valproate (Episenta) M Sachets (1g, 500mg) Sodium Valproate (Epilim) rushabletablets (100mg) Sodium Valproate (Epilim) Syrup (200mg/5ml) Vigabatrin Tablets (500mg) Vigabatrin Sachets (500mg) Formulary S Topiramate Tablets (25mg, 50mg, 100mg, 200mg) Topiramate Sprinkle aspules (15mg, 25mg) Gabapentin apsules (100mg, 300mg, 400mg) onsultant Neurologist use only Specailist departmental use only Drugs used in epilepticus lonazepam Injection (1mg/1ml) Diazepam Emulsion Injection (10mg/2ml) Diazepam Injection (10mg/2ml) Diazepam ectal Tubes (2.5mg, 5mg, 10mg) Lorazepam Injection (4mg/1ml) Paraldehyde Injection (5ml) Paraldehyde/ Olive Oil Enema 50% (10ml) Formulary Buccolam Midazolam Oromucosal Solution 5mg/ml: 0.5ml (2.5mg) prefilled syringes 1ml (5mg) prefilled syringes 1.5ml (7.5mg) prefilled syringes 2ml (10mg) prefilled syringes Please note Schedule 3 D and is subject to special prescription requirements and to safe custody requirements. For onsultant Paediatrician use in the community setting as an alternative to rectal diazepam for epilepticus. For use in A&E as an alternative to rectal diazepam for epilepticus for children and adolescents. For use by the palliative care team as an alternative to rectal diazepam for patients dying at home. For supply to Dental linics for use in case of medical emergency Please note this is a different strength to the unlicensed product.

20 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 20 of 25 Although records in registers do not need to be kept we have decided at ANHSFT that we will keep a D register for these both in pharmacy and on the wards where it is stocked (A&E and ward 17) Epi Midazolam Buccal liquid (10mg/1ml) 4ml bottle with measuring syringes provided. It should be prescribed by the brand name with the dose in mls and mgs. Dose by buccal adminisatration: Adult over 18 [unlicensed], 10mg repeated once after 10minutes if necessary hild up to 6 months [unlicensed], 300micrograms/kg (max 2.5mg), 6months -1year 2.5mg, 1-5 years 5mg, 5 10 years 7.5mg, years 10mg; these doses may be repeated once after 10minutes if necessary This is an unlicensed preparation and requires the unlicensed medicines paperwork filling in by the consultant. It should only be used if the doses available in the licensed preparation are not appropriate. Please note this is a different strength to the licensed product. It should be prescribed by the brand name with the dose in mls and mgs. 4.9 Drugs used in parkinsonism and related disorders Dopaminergic drugs used in parkinsonism Dopamine receptor agonists o-beneldopa apsules (12.5/50, 25/100) o-beneldopa M apsules (25/100) o-beneldopa Dispersible Tablets (12.5/50, 25/100) o-careldopa Tablets (12.5/50, 25/100, 10/100, 25/250) o-careldopa M Tablets (25/100, 50/200) Formulary Apomorphine Pens (30mg/3ml, 50mg/10ml) onsultant Neurologist and Department of Elderly Medicine

21 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 21 of 25 Pramipexole tablets 88micrograms base = 125micrograms salt 180micrograms base = 250micrograms salt 350micrograms base = 500micrograms salt 700micrograms base = 1mg salt opinirole Tablets (250mcg, 1mg, 2mg, 3mg, 5mg) opinirole S tablets (2mg, 4mg, 8mg) opinirole Starter Pack otigotine transdermal patches (2mg, 4mg, 6mg, 8mg/24h) Monoamine-oxidase-B inhibitors Selegiline Tablets (5mg) Selegiline Liquid (10mg/5ml) Physician use only onsultant Neurologist and Department of Elderly Medicine Physician use only. eserved for patients WITH Parkinson s disease who have not responsed to or who are intolerant of ropinirole. Moderate to severe restless leg syndrome onsultant Neurologist and Department of Elderly Medicine Physician use only estricted to use in patients with advanced Parkinson s disease with swallowing difficulties Formulary asagiline tablets 1mg onsultant Neurologist and Department of Elderly Medicine Physician use only. For patients intolerant of selegiline or who are likely to develop psychotic side effects or sleep disturbances as a result of treatment atechol-o-methyltransferase inhibitors Formulary S Entacapone tablets 200mg For specialist initiation only Glutamate inhibitors Formulary Amantadine capsules 100mg For use by onsultant Neurologist and Department of Elderly Medicine Physicians

22 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 22 of 25 ombination s in-line with NIE G35 Formulary Stalevo tablets (o-careldopa + entacapone) (50mg/12.5mg/200mg, 75mg/18.75mg/200mg, 100mg/25mg/200mg, 150mg/37.5mg/200mg, 200mg/50mg/200mg) estricted to patients with Parkinson s disease requiring triple therapy with levodopa, carbidopa and entacapone Antimuscarinic drugs used in parkinsonism Orphenadrine Elixir (25mg/5ml) Orphenadrine Tablets (50mg) Procyclidine Tablets (5mg) Procyclidine Injection (10mg/2ml) Procyclidine SF Syrup (5mg/5ml) Trihexyphenidyl Syrup (5mg/5ml) Trihexyphenidyl Tablets (2mg, 5mg) Drugs used in essential tremor, chorea, tics, and related disorders Tetrabenazine Tablets (25mg) Formulary Botulinum A Toxin 100unit vial (Botox Injection) estricted to onsultant Urologist/Neurologist/Orthopaedic/Maxillofacial use only. All other requests should be authorised by a senior clinical pharmacist. Botox units are not equivalent to Dysport units.

23 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 23 of 25 Botulinum A Toxin 100units vial (Xeomin Injection) Botulinum B Toxin 2,500units in 0.5ml (Neurobloc Injection) onsultant in ehab Medicine has agreed to use this brand for her patients if clinically appropriate. Xeomin units are considered to be equivalent to Botox units For use by onsultant Neurologist in patients who have been transeferred from Leeds back to ANHSFT iluzole tablets (50mg) onsultant Neurologist use only. For patients with AML form of motor neurone disease

24 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 24 of Drugs used in substance dependence Buprenorphine Tablets (Subutex) (2mg, 8mg) Nicotine patches Nicorette inhalator 10mg refill Nicorette inhalator Starter Pack Nicotinell 1mg lozenges Niquitin Q 7mg patches (24 hour) Niquitin Q 14mg patches (24 hour) Niquitin Q 21mg patches (24 hour) Niquitin Minis lozenges 1.5mg, 4mg Formulary Acamprosate E/ Tablets onsultant Psychiatrist use only (333mg) Methadone Mixture (1mg/1ml) estricted for treatment of opioid addiction Methadone SF Mixture (1mg/1ml) Methadone Tablets (5mg) Methadone Injection (10mg/1ml) Nicorette 2mg gum Initiated by smoking cessation nurse. Niquitin Q Lozenges (2mg, Initiated by smoking cessation nurse. 4mg) Varenicline Tablets (0.5mg, 1mg) Initiated by smoking cessation nurse or for existing patients. Varenicline Tablets Initiation Pack For use in-line with NIE TA123 (July 2007) Initiated by smoking cessation nurse. For use in-line with NIE TA123 (July 2007)

25 Original Date of issue: 26/11/2005 Last eviewed:10/10/2012 Version:4 Page 25 of 25 Formulary 4.11 Drugs for dementia Donepezil Tablets (5mg, 10mg) Donepezil orodispersible Tablets (10mg) Galantamine Solution (4mg/ml) Galantamine Tablets (8mg) For treatment of moderate Alzheimer s disease. onsultant Psychiatrist and Department of Elderly Medicine Physician use only. For use in-line with NIE TA217 (March 2011). estricted for BDT, 8mg must not be halved, 4mg doses use solution. For use in-line with NIE TA217 (March 2011). Memantine Tablets 10mg For use in-line with NIE TA217 (March 2011). ivastigmine apsules 1.5mg, 3mg, 4.5mg, 6mg ivastigmine oral solution (2mg/ml) ivastigmine transdermal patches (4.6mg/24hrs, 9.5mg/24hrs) For the treatment of Parkinson s disease dementia. Treatment initiated at ANHSFT and continued in Primary are under a Shared are Guideline. For other indications - estricted to Bradford District are Trust and patients who come in on it. For use in-line with NIE TA217 (March 2011).