North West London Integrated Formulary

Transcription

1 North West London Integrated Formulary PUBLISHED VERSION (v ) The Integrated Formulary (IF) is a list of medicines for adult patients and is for use in North West London. The IF is intended to cover: prescriptions written in primary care; prescriptions or recommendations by hospital doctors in respect of outpatients or patients leaving hospital after an admission. The IF should be taken fully into account by prescribers when exercising their clinical judgement. However, it does not override the individual responsibility of prescribers to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer and informed by the summary of product characteristics of any medicines they are considering. Medicines recommended by NICE technology appraisal guidance (TAG) are regarded as included in the IF from the date the TAG is published, unless: the medicine will only be prescribed for hospital inpatients or it is deemed to be a medicine that should only be prescribed by a hospital specialist (in which case it will be added to the NWL red list of medicines that a hospital doctor should not ask a GP to prescribe). People currently receiving a medicine that is not included in the IF should have the option to continue until they and their clinicians consider it appropriate to stop. initiation A number of medicines in the IF are marked specialist initiation. These words should be interpreted as an attempt to reduce the risk of harm and taken into account by prescribers when exercising their clinical judgement. Appropriate action in response to a specialist initiation annotation may lie anywhere in a spectrum between: 1. The medicine should be prescribed by a relevant specialist for at least x months with monitoring of effectiveness and toxicity, until treatment is stable at which point the patient s GP can be asked whether s/he will take over prescribing, and 2. It is reasonable for a GP to write the first prescription after a telephone conversation with a relevant specialist clinician. Different GPs might reasonably take different decisions regarding whether or when to prescribe, depending on their knowledge and experience. Legal responsibility for prescribing lies with the doctor who signs the prescription. The specialist initiation annotations say nothing about who is or is not a relevant specialist in respect of a medicine. It will be reasonable for some of these medicines to be initiated by prescribers from more than one speciality. BNF chapter BNF section BNF sub-section 1.1 Dyspepsia and gastro-oesophageal reflux disease Antacids and simeticone Drug name (shading indicates that the drug appears in more than one section) Co-magaldrox (prescribe Mucogel) Formulations co-magaldrox 195/220 suspension DRAFT Order of preference Initiate by specialist only? Comments Low sodium. Mucogel costs less than Maalox. 1.1 Dyspepsia and gastro-oesophageal reflux disease Antacids and simeticone Asilone dried aluminium hydroxide 420 mg, simeticone 135 mg, light magnesium oxide 70 mg/5 ml Contains simeticone. Costs slightly more than Mucogel 1.1 Dyspepsia and gastro-oesophageal reflux disease Antacids and simeticone Magnesium trisilicate mixture oral suspension, 5% each of magnesium trisilicate, light magnesium carbonate, and sodium bicarbonate in a suitable vehicle with a peppermint flavour Tends to be laxative. Contains approx 6mmol sodium/10ml 1.1 Dyspepsia and gastro-oesophageal reflux disease 1.1 Dyspepsia and gastro-oesophageal reflux disease Compound alginates Peptac Compound alginates Gastrocote suspension (peppermint or aniseed) tablets, chewable. Contains alginate. Contains 6.2mmol sodium in 10ml. Alginate containing tablets. Liquid antacid are more effective than tablets. 1.1 Dyspepsia and gastro-oesophageal reflux disease 1.2 Antispasmodics and other altering gastric motility Compound alginates Gaviscon Infant oral powder; 1.2 Mebeverine hydrochloride tablets 135 mg Contains alginate and 0.92mmol sodium /dose.

2 1.2 Antispasmodics and other altering gastric motility 1.2 Antispasmodics and other altering gastric motility 1.3 Anti-secretory and mucosal protectants H2- receptor antagonists Peppermint oil (prescribe Mintec) Hyoscine butylbromide Ranitidine e/c capsules 0.2ml tablets 10mg; injection 20mg in 1ml tablets 150mg, 300mg; effervescent tablets 150mg; oral solution 75mg in 5ml Mintec capsules cost less than MR Colpermin capsules Ranitidine tablets now cost less than cimetidine tablets. Effervescent tablets cost much more than plain tablets. 1.3 Anti-secretory and mucosal protectants 1.3 Anti-secretory and mucosal protectants Chelates and complexes Sucralfate Proton pump inhibitors Esomeprazole tablets 1g; suspension 1g in 5ml tablets 20mg, 40mg See comments column Costs much more than omeprazole, lansoprazole or pantoprazole. Esomeprazole should only be used for initial treatment (e.g. 8 weeks) of endoscopically proven severe oesophagitis. Maintenance treatment, if required, can generally be with a low cost PPI. 1.3 Anti-secretory and mucosal protectants Proton pump inhibitors Omeprazole capsules 10mg, 20mg; dispersible tablets, film-coated, 10mg, 20mg Capsules cost much less than dispersible tablets 1.3 Anti-secretory and mucosal protectants 1.3 Anti-secretory and mucosal protectants 1.3 Anti-secretory and mucosal protectants Proton pump inhibitors Pantoprazole Proton pump inhibitors Lansoprazole 1.4 Acute diarrhoea Loperamide 1.4 Acute diarrhoea Co-phenotrope 1.5 Chronic bowel disorders Aminosalicylates Mesalazine tablets 20mg, 40mg orodispersible tablet, 15mg, 30mg (Fastab ); capsules 15mg, 30mg Test for Helicobacter pylori diabact UBT capsules 2mg; syrup 1mg in 5ml tablets 2.5/0.025 e/c tablets 400mg (Asacol MR, Octasa - see comments), 800mg (Asacol MR and Octasa ); MR tablets 500mg (Pentasa ); MR tablets 1.2g (Mezavant XL - see comments) gastro-resistant prolonged release granules 500mg, 1g (Salofalk ); retention enema 1g in 100ml; enema 2g in 59ml; foam enema 1g/application; suppositories 250mg, 500mg, 1g Capsules cost much less than orodispersible tablets Arrangements for H. pylori testing differ in different parts of NWL Codeine Phosphate may also be used as a diarrhoea treatment - see section There is no evidence to show that any one oral preparation of mesalazine is more effective than another; however, the delivery characteristics of oral mesalazine may vary. If it is necessary to switch a patient to a different brand of mesalazine, the patient should be advised to report any changes in symptoms Octasa is the lowest cost brand and should be prescribed instead of other brands for new patients, and for patients who require a change to their drug regimen. Discretion should be applied in switching patients to Octasa who have mild and/or stable UC. Mezavant XL should only be considered for select patients experiencing difficultly with a high pill burden (i.e. >2.4g/daily), since it has a convenient once-daily dosing advantage. Since Mezavant XL is almost twice the cost of Octasa, at the point of maintenance dose prescribing (i.e. 2.4g/daily), Octasa should be substituted. 1.5 Chronic bowel disorders Aminosalicylates Sulfasalazine (Sulphasalazine) 1.5 Chronic bowel disorders Aminosalicylates Olsalazine 1.5 Chronic bowel disorders Aminosalicylates Balsalazide 1.5 Chronic bowel disorders Corticosteroids Prednisolone tablets 500mg; e/c tablets 500mg; suspension 250mg in 5ml; suppositories 500mg capsules 250mg capsules 750 mg retention enema, short tube, 20mg in 100ml (as sodium phosphate); foam enema, 20mg per metered application (as sodium metasulphobenzoate); suppositories 5mg (as sodium phosphate)

3 1.5 Chronic bowel disorders Corticosteroids Hydrocortisone acetate 1.5 Chronic bowel disorders Corticosteroids Budesonide foam, in aerosol pack, 10% as acetate (Colifoam ) e/c MR capsules 3mg Causes fewer side-effects than oral prednisolone but may be less effective. Prescribe by brand name. 1.6 Laxatives - see BNF for comments on the role of laxatives 1.6 Laxatives - see BNF for comments on the role of laxatives Bulk-forming laxatives Ispaghula husk Stimulant laxatives Senna granules 3.5g/sachet (orange flavoured or plain) tablets total sennosides 7.5mg; syrup total sennosides 7.5mg in 5ml 1.6 Laxatives - see BNF for comments on the role of laxatives Stimulant laxatives Glycerol (glycerin) suppositories, 1g (infant), 2g (child), 4g (adult); 1.6 Laxatives - see BNF for comments on the role of laxatives 1.6 Laxatives - see BNF for comments on the role of laxatives Stimulant laxatives Docusate sodium Stimulant laxatives Co-danthramer capsules 100mg; oral solution 12.5mg in 5ml, 50mg in 5ml capsules 25/200 (dantron 25 mg, poloxamer mg), strong capsules 37.5/500 (dantron 37.5 mg, poloxamer mg); suspension 25/200 (dantron 25 mg, poloxamer mg) in 5ml; strong suspension 75/1000 (dantron 75 mg, poloxamer g) in 5ml Acts both as a stimulant and a softening agent Only licensed for constipation in terminally ill patients. 1.6 Laxatives - see BNF for comments on the role of laxatives Stimulant laxatives Bisacodyl e/c tablets 5mg; suppositories 10mg; paediatric suppositories 5mg. 1.6 Laxatives - see BNF for comments on the role of laxatives 1.6 Laxatives - see BNF for comments on the role of laxatives Osmotic laxatives Lactulose Osmotic laxatives Macrogol compound oral powder solution Laxido Orange oral powder sachets; Laxido paediatric plain powder sachets; Movicol-Half powder sachets; Movicol Paediatric Plain powder sachets Laxido Orange costs less than Movicol enema BP Formula B 1.6 Laxatives - see BNF for comments on the role of laxatives Osmotic laxatives Phosphates 1.6 Laxatives - see BNF for comments on the role of laxatives 1.6 Laxatives - see BNF for comments on the role of laxatives Osmotic laxatives Other used in constipation Micralax Microenema Prucalopride enema tablets 1mg, 2mg For use in line with NICE's guidance. 1.6 Laxatives - see BNF for comments on the role of laxatives 1.6 Laxatives - see BNF for comments on the role of laxatives 1.6 Laxatives - see BNF for comments on the role of laxatives 1.7 Local for anal and rectal disorders 1.7 Local for anal and rectal disorders Other used in constipation Other used in constipation Other used in constipation Soothing haemorrhoidal prepaarations Compound haemorrhoidal with corticosteroids Naloxegol Lubiprostone Linaclotide Anusol Xyloproct tablets 12.5mg, 25mg capsules 24 microgram capsules 290 microgram Anusol Suppositories, Ointment, Cream Ointment (water-miscible), aluminium acetate 3.5%, hydrocortisone acetate 0.275%, lidocaine 5%, zinc oxide 18% For use in line with NICE TA345 For use in line with NICE TA318 Can be purchased over the counter. First choice if corticosteroid required

4 1.7 Local for anal and rectal disorders Compound haemorrhoidal with corticosteroids Scheriproct Suppositories, cinchocaine (dibucaine) hydrochloride 1mg, prednisolone hexanoate 1.3mg Ointment, cinchocaine (dibucaine) hydrochloride 0.5%, prednisolone hexanoate 0.19%. Second choice if corticosteroid containing suppositories required 1.7 Local for anal and rectal disorders Compound haemorrhoidal with corticosteroids Proctofoam HC Foam in aerosol pack, hydrocortisone acetate 1%, pramocaine hydrochloride 1%. 1.7 Local for anal and rectal disorders Management of anal fissures Diltiazem rectal cream 2% (unlicensed)) For treatment of anal fissure. Generally not suitable for repeat prescribing 1.7 Local for anal and rectal disorders 1.9 Drugs affecting intestinal secretions Management of anal fissures Glyceryl trinitrate Ursodeoxycholic acid 1.9 Drugs affecting intestinal secretions Creon rectal ointment 0.4% (Rectogesic ) tablets 150mg; capsules 250mg Creon Capsules,e/c granules of pancreatin (pork), providing: protease 600 units, lipase units, amylase 8000 units; capsules For treatment of anal fissure. Generally not suitable for repeat prescribing 2.1 Positive inotropic Digoxin tablets 62.5mcg, 125mcg, 250mcg; elixir 50mcg in 1ml; 2.2 Diuretics Thiazides and related diuretics Indapamide tablets 2.5mg; MR tablets 1.5mg Plain tablets cost much less than MR tablets, but both are less than 3.50 per month 2.2 Diuretics 2.2 Diuretics Thiazides and related diuretics Thiazides and related diuretics Chlortalidone Bendroflumethiazide tablets 50mg tablets 2.5mg, 5mg NICE's guideline on hypertension now recommends indapamide or chlortalidone rather than bendroflumethiazide or hydrochlorothiazide. People taking the latter whose BP is stable and well controlled should continue on the drug. 2.2 Diuretics Loop diuretics Furosemide tablets 20mg, 40mg, 500mg; oral solution 20mg in 5ml, 40mg in 5ml, 50mg in 5ml; 2.2 Diuretics Loop diuretics Bumetanide tablets 1mg, 5mg; Liquid 1mg in 5ml. 1mg costs slightly more than furosemide 40mg 2.2 Diuretics Loop diuretics Torasemide Potassium-sparing 2.2 Diuretics diuretics and aldosterone Eplerenone antagonists Potassium-sparing 2.2 Diuretics diuretics and aldosterone antagonists Spironolactone tablets tablets 25mg, 50mg tablets 25mg, 100mg; 50 mg See comments column For resistent oedema in patients with low egfr or poor tablet absorbtion Costs much more than spironolactone. 2.2 Diuretics Potassium-sparing diuretics and aldosterone antagonists Amiloride tablets 5mg; oral solution 5mg in 5ml

5 2.2 Diuretics Potassium-sparing diur Co-amilozide tablets 2.5/25 (amiloride hydrochloride 2.5 mg, hydrochlorothiazide 25 mg), 5/50 (amiloride hydrochloride 5 mg, hydrochlorothiazide 50 mg) NICE's guideline on hypertension now recommends indapamide or chlortalidone rather than bendroflumethiazide or hydrochlorothiazide. People taking the latter whose BP is stable and well controlled should continue on the drug. 2.2 Diuretics Potassium-sparing diur Co-amilofruse tablets 2.5/20 (amiloride hydrochloride 2.5 mg, furosemide 20 mg), 5/40 (amiloride hydrochloride 5 mg, furosemide 40 mg) tablets 150mg, 300mg 2.3 Anti-arrhythmic Propafenone 2.3 Anti-arrhythmic Flecainide 2.3 Anti-arrhythmic Disopyramide 2.3 Anti-arrhythmic Amiodarone 2.4 Beta-adrenoceptor blocking 2.4 Sotalol tablets 50mg, 100mg; capsules 100mg, 150mg; tablets 100mg, 200mg; tablets 40mg, 80mg, 160mg, 200mg 2.4 Beta-adrenoceptor blocking 2.4 Nebivolol tablets 5mg 2.4 Beta-adrenoceptor blocking 2.4 Labetalol tablets 50mg, 100mg, 200mg, 400mg; 2.4 Beta-adrenoceptor blocking 2.4 Bisoprolol tablets 1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg 3.75mg and 7.5mg tablets cost more than the other strengths 2.4 Beta-adrenoceptor blocking 2.4 Carvedilol 2.4 Beta-adrenoceptor blocking 2.4 Propranolol tablets 3.125mg, 6.25mg, 12.5mg, 25mg tablets 10mg, 40mg, 80mg,160mg; MR capsules 80mg, 160mg; oral solution (Syprol brand) 5mg in 5ml, 10mg in 5ml, 50mg in 5ml Second choice beta-blocker for heart failure. Costs more than bisoprolol If prescribing propranolol oral liquid, we suggest prescribing the Syprol brand to avoid high cost 'special' being dispensed. tablets 50mg, 100mg; 2.4 Beta-adrenoceptor blocking 2.4 Metoprolol 2.4 Beta-adrenoceptor blocking 2.4 Atenolol 2.5 Hypertension and heart failure Vasodilator antihypertensive Hydralazine tablets 25mg, 50mg, 100mg; syrup 25mg in 5ml; tablets 25mg, 50mg; 2.5 Hypertension and heart failure 2.5 Hypertension and heart failure 2.5 Hypertension and heart failure 2.5 Hypertension and heart failure 2.5 Hypertension and heart failure Vasodilator antihypertensive Centrally acting antihypertensive Centrally acting antihypertensive Alpha-adrenoceptor blocking Alpha-adrenoceptor blocking Minoxidil Moxonidine Methyldopa Phenoxybenzamine Doxazosin tablets 2.5mg, 5mg, 10mg tablets 200mcg, 300mcg, 400mcg tablets 125mg, 250mg, 500mg capsules 10mg tablets 1mg, 2mg, 4mg First choice if an alpha-blocker is needed for hypertension, except in phaeochromocytoma. Modified release tablets cost more than plain tablets.

6 2.5 Hypertension and heart failure Angiotensinconverting enzyme inhibitors Ramipril capsules or tablets 1.25mg, 2,5mg, 5mg, 10mg Ramipril capsules cost slightly less than tablets 2.5 Hypertension and heart failure Angiotensinconverting enzyme inhibitors Lisinopril tablets 2.5mg, 5mg, 10mg, 20mg 2.5 Hypertension and heart failure Angiotensinconverting enzyme inhibitors Perindopril erbumine tablets 2mg, 4mg, 8mg Perindopril erbumine costs more than the other ACE inhibitors listed here. Perindopril arginine (non-formulary) costs much more. 2.5 Hypertension and heart failure Angiotensinconverting enzyme inhibitors Enalapril tablets 2.5mg, 5mg, 10mg, 20mg 2.5 Hypertension and heart failure Angiotensinconverting enzyme inhibitors Captopril tablets 12.5mg, 25mg, 50mg 2.5 Hypertension and heart failure Angiotensin-II receptor antagonists Losartan tablets 25mg, 50mg, 100mg, 12.5 mg NICE's guideline on hypertension now recommends a low cost ARB as an option for step 1 treatment of people aged under 55, and as a step 2 option for older people or black people of African or Caribbean family origin. Losartan is currently the only ARB available generically at low cost. capsules 40mg, 80mg, 160mg 2.5 Hypertension and heart failure Angiotensin-II receptor antagonists Valsartan 2.5 Hypertension and heart failure 2.5 Hypertension and heart failure Angiotensin-II receptor antagonists Angiotensin-II receptor antagonists Irbesartan Candesartan tablets 75mg, 150mg, 300mg tablets 2mg, 4mg, 8mg, 16mg, 32mg Generic unlikely before Possibility that company will obtain additional 6 months protection by getting the drug licensed for use in 2.5 Hypertension and heart failure Renin inhibitors Aliskiren 2.6 Nitrates, Calcium-channel blockers and other antianginal Nitrates Isosorbide mononitrate tablets 150mg, 300mg tablets 10mg, 20mg; MR capsules 25mg, 50mg; MR tablets 25mg, 40mg, 60mg Not included in NICE's clinical guideline on hypertension 2.6 Nitrates, Calcium-channel blockers and other antianginal Nitrates Glyceryl trinitrate aerosol spray 400mcg/metered spray; tablets 500 micrograms The tablets should be discarded after 8 weeks in use, so the spray generally provides better value for money. 2.6 Nitrates, Calcium-channel blockers and other antianginal Calcium-channel blockers Verapamil tablets 40mg, 80mg,120mg; MR capsules 120mg; MR tablets 240mg; oral solution 40mg in 5ml 2.6 Nitrates, Calcium-channel blockers and other antianginal Calcium-channel blockers Nifedipine capsules 5mg, 10mg; Modified release - prescribers should specify the brand to be dispensed (see BNF) Potential confusion between MR brands probably means that a drug that does not require modified release formulations, such as amlodipine, is preferable for treatment of hypertension. If using MR nifedipine, prescribe by brand. 2.6 Nitrates, Calcium-channel blockers and other antianginal Calcium-channel blockers Diltiazem Standard MR tablets 60mg; Longer-acting formulations - prescriber should specify the brand to be dispensed (see BNF). Prescribe longer-acting formulations by brand name. tablets 5mg, 10mg 2.6 Nitrates, Calcium-channel blockers and other antianginal Calcium-channel blockers Amlodipine 2.6 Nitrates, Calcium-channel blockers and other antianginal Other antianginal Nicorandil tablets 10mg, 20mg

7 2.6 Nitrates, Calcium-channel blockers and other antianginal Other antianginal Ivabradine tablets 5mg, 7.5mg tablets 3rd line treatment in patients with refractory angina where re-vascularisation is not appropriate and who continue to suffer from angina despite otherwise maximum anti-angina treatment or for patients unable to tolerate or with a contraindication to beta-blocker or an appropriate calcium channel blocker. In line with NICE guidance TA267 for chronic heart failure. 2.6 Nitrates, Calcium-channel blockers and other antianginal Other antianginal Ranolazine 2.6 Nitrates, Calcium-channel blockers and other antianginal 2.8 Anticoagulants and protamine Peripheral vasodilators and related Parenteral anticoagulants Naftidrofuryl Tinzaparin capsules 100mg injection syringe 2500 units, 3500 units, 4500 units, 10,000 units, 14,000 units, 18,000 units Hospital doctors should only ask GPs to prescribe this (1) if a shared care document has been agreed by the hospital and relevant primary care organisation or (2) as part of palliative care 2.8 Anticoagulants and protamine Parenteral anticoagulants Heparin sodium or calcium Subcutaneous injection 5,000units in 0.2ml; pre-filled syringes 5,000units in 0.2ml, Hospital doctors should only ask GPs to prescribe this (1) if a shared care document has been agreed by the hospital and relevant primary care organisation or (2) as part of palliative care 2.8 Anticoagulants and protamine Parenteral anticoagulants Enoxaparin injection syringe 20mg in 0.2ml, 40mg in 0.4ml, 60mg in 0.6ml, 80mg in 0.8ml, 100mg in 1ml, 120mg in 0.8ml, 150mg in 1ml Hospital doctors should only ask GPs to prescribe this (1) if a shared care document has been agreed by the hospital and relevant primary care organisation or (2) as part of palliative care 2.8 Anticoagulants and protamine Parenteral anticoagulants Dalteparin injection syringe 2500 units, 5000 units, 7500 units, 10,000 units, 12,500 units, 15,000 units, 18,000 units Hospital doctors should only ask GPs to prescribe this (1) if a shared care document has been agreed by the hospital and relevant primary care organisation or (2) as part of palliative care tablets 10mg, 25mg, 50mg Intermittent supply problems. INR monitoring required. 2.8 Anticoagulants and protamine Oral anticoagulants Phenindione 2.8 Anticoagulants and protamine Oral anticoagulants Phenindione 2.8 Anticoagulants and protamine Oral anticoagulants Dabigatran etexilate tablets 1mg capsules, 110mg, 150mg INR monitoring required NICE TA guidance exists 2.8 Anticoagulants and protamine Oral anticoagulants Rivaroxaban tablets 15mg, 20mg NICE TA guidance exists 2.8 Anticoagulants and protamine Oral anticoagulants Apixaban tablets 2.5mg, 5mg NICE TA guidance exists 2.8 Anticoagulants and protamine Oral anticoagulants Edoxaban tablets 15mg, 30mg, 60mg NICE TA guidance exists 2.8 Anticoagulants and protamine Oral anticoagulants Warfarin 2.9 Antiplatelet 2.9 Prasugrel 2.9 Antiplatelet 2.9 Dipyridamole tablets 500mcg, 1mg, 3mg, 5mg tablets 5mg, 10mg tablets 25mg, 100mg; MR capsules 200mg; oral liquid 50mg in 5ml INR monitoring required Use in line with NICE's guidance Use in line with NICE's guidance 2.9 Antiplatelet 2.9 Clopidogrel tablets 75mg Use in line with NICE's guidance 2.9 Antiplatelet 2.9 Aspirin tablets dispersible 75mg Enteric coated tablets cost more than dispersible tablets.

8 2.9 Antiplatelet 2.9 Asasantin Retard Capsules, aspirin 25 mg, dipyridamole 200 mg (m/r) Use in line with NICE's guidance 2.11 Antifibrinolytic and haemostatics 2.11 Antifibrinolytic and haemostatics 2.9 Antiplatelet 2.9 Ticagrelor 2.11 Etamsylate 2.11 Tranexamic acid 2.12 Lipid-regulating Statins Simvastatin 2.12 Lipid-regulating Other Colestyramine (cholestyramine) 2.12 Lipid-regulating Statins Rosuvastatin 2.12 Lipid-regulating Other Colesevelam 2.12 Lipid-regulating Statins Atorvastatin 2.12 Lipid-regulating Statins Pravastatin 2.12 Lipid-regulating Other Omacor (omega-3 acid ethyl esters) 2.12 Lipid-regulating Fibrates Fenofibrate tablets 90mg tablets 500mg tablets 500mg tablets 10mg, 20mg, 40mg, 80mg powder 4g per sachet (Questran Light ); powder, 4g sachets (Questran ). tablets 5mg, 10mg, 20mg, 40mg tablets 625mg tablets 10mg, 20mg, 40mg, 80mg tablets 10mg, 20mg, 40mg capsules 1g (Omacor ). See comments column See comments column capsules (micronised) 67mg, 200mg, 267mg; tablets (micronised) 160mg For use in line with NICE guidance for selected post PCI patients First choice except 1) after an acute coronary syndrome, 2) in most patients with familial hypercholesterolaemia. resin Rosuvastatin is included for very limited use in line with the protocol below. Low cost generic rosuvastatin is unlikely to be available before Generic atorvastatin will be available from May Rosuvastatin 20mg daily currently costs 338 p.a. in general practice; generic simvastatin 40mg daily Costs costs more 15. than colestyramine, but the latter may not be tolerated. For secondary prevention post myocardial infarction (MI) in line with NICE's guideline on secondary prevention of MI, if patients are not able to eat 7g of omega 3 fatty acid per week Lipid-regulating Other Ezetimibe tablets 10mg For use in line with NICE's guidance. tablets 200mg; MR tablets 400mg 2.12 Lipid-regulating Fibrates Bezafibrate 3.1 Bronchodilators Selective beta2 agonists Indacaterol 150 microgram inhalation powder, hard capsules; 300 microgram inhalation powder, hard capsules ICHT limited release - For maintenance bronchodilator treatment of airflow obstruction in adults with COPD on the recommendation of a respiratory physician. Only licensed for COPD. 3.1 Bronchodilators Selective beta2 agonists Salbutamol Aerosol inhalation 100 micrograms/metered inhalation; Airomir Autohaler (breathactuated) 100 micrograms/metered Turbohaler 500mcg/inhalation; Respules 5mg in 2ml Second choice short-acting beta2 agonist 3.1 Bronchodilators Selective beta2 agonists Terbutaline 3.1 Bronchodilators Selective beta2 agonists Salmeterol aerosol inhalation 25mcg/metered inhalation; Accuhaler 50mcg/blister;

9 3.1 Bronchodilators Selective beta2 agonists Formoterol Turbohaler 6mcg/inhalation, 12mcg/inhalation; inhalation capsules 12mcg 3.1 Bronchodilators Antimuscarinic bronchodilators Tiotropium dry powder inhaler 18mcg capsule; Respimat solution for inhalation 2.5micrograms/metered inhalation The Scottish Medicines Consortium has restricted the Respimat for use in COPD in patients who have poor manual dexterity and difficulty using the dry powder device. 3.1 Bronchodilators Antimuscarinic bronchodilators Ipratropium bromide aerosol inhalation 20mcg/metered inhalation; nebuliser solution 250mcg in 1ml, 500mcg in 2ml unit dose vials 3.1 Bronchodilators Antimuscarinic bronchodilators Glycopyrronium bromide Inhalation powder 50 mcg, hard capsule, for use with Seebri Breezhaler device For use as a second line option in the maintenance treatment of COPD. 3.1 Bronchodilators Antimuscarinic bronchodilators Aclidinium bromide Dry powder inhaler 375 mcgs(= aclidinium 322 mcg)/inhalation (delivered dose) for use with Eklira Genuair device For use as a second line option in the maintenance treatment of COPD. 3.1 Bronchodilators Theophylline Theophylline MR tablets (Uniphyllin Continus) 200mg, 300mg, 400mg; MR capsules 60mg, 125mg, 250mg (Slo-Phyllin) Rate of absorption can vary between brands. Maintain the patient on the brand s/he has been stabilised on. 3.1 Bronchodilators Theophylline Aminophylline MR tablets (Phyllocontin) 225mg, 350mg; Peak flow meters, inhaler devices and nebulisers Peak flow meters, inhaler devices and nebulisers Drug delivery devices Peak flow meters spacer devices Vitalograph (standard & child) 3.2 Corticosteroids 3.2 Fostair aerosol inhalation, beclometasone dipropionate 100mcg, formoterol fumarate 6mcg per metered inhalation. NEXThaler (dry powder inhaler containing beclometasone dipropionate 100mcg plus formoterol fumarate 6mcg per metered inhalation.) Step down treatment in line with NICE's guidance 3.2 Corticosteroids 3.2 Symbicort 3.2 Corticosteroids 3.2 DuoResp Spiromax Turbohaler 100/6, 200/6, 400/12 dry powder for inhalation 160mcg/4.5mcg and 320mcg/9mcg. Containing budesonide (160mcg and 320mcg) and formoterol (4.5mcg and 9mcg) Step down treatment in line with NICE's guidance Step down treatment in line with NICE's guidance

10 3.2 Corticosteroids 3.2 Flutiform aerosol inhalation 50 and 125 (aerosol containing 5mcg formoterol plus 50/125 mcg fluticasone/metered inhalation. aerosol inhalation 250 (aerosol containing 10mcg formoterol plus 250 mcg fluticasone/metered inhalation) Step down treatment in line with NICE's guidance 3.2 Corticosteroids 3.2 Relvar Ellipta dry powder for inhalation 92mcg/22mcg and 184mcg/22mcg. Containing vilanterol 22micrograms plus fluticasone furoate 92/184micrograms per delivered dose. Step down treatment in line with NICE's guidance 3.2 Corticosteroids 3.2 Seretide Accuhaler 100, 250, 500 (dry powder breath-actuated disc inhaler containing 50mcg salmeterol plus 100/250/500mcg fluticasone) Evohaler 50, 125, 250 (aerosol containing 25mcg salmeterol plus 50/125/250mcg fluticasone/metered inhalation) Step down treatment in line with NICE's guidance. At the highest dose, Accuhalers (powder devices) cost much less than Evohalers (pressurised aerosols) and avoid use of HFA propellants which are greenhouse gases. 3.2 Corticosteroids 3.2 Sirdupla aerosol inhalation 125 and 250 (aerosol containing 25mcg salmetrol plus 125/250mcg fluticasone/metered inhalation) Step down treatment in line with NICE's guidance. 3.2 Corticosteroids 3.2 Fluticasone Evohaler aerosol inhalation 50mcg/metered inhalation, 125mcg/metered inhalation, 250mcg/metered inhalation; Accuhaler 50mcg/blister, 100mcg/blister, 250mcg/blister, 500mcg/blister 3.2 Corticosteroids 3.2 Budesonide Turbohaler 100mcg/inhalation, 200mcg/inhalation, 400mcg/inhalation; Respules 500mcg in 2ml, 1mg in 2ml

11 3.2 Corticosteroids 3.2 Beclometasone dipropionate CFC-free aerosol inhalation 50mcg/metered inhalation, 100mcg/metered inhalation, 250mcg/metered inhalation (Clenil Modulite ); CFC-free aerosol inhalation 50mcg/metered inhalation, 100mcg/metered inhalation (Qvar ); Breath-actuated aerosol inhalation 50 micrograms/metered inhalation, 100micrograms/metered inhalation (Qvar Autohaler, Qvar Easi-Breathe); Dry powder inhalation 100, 200, 400 micrograms (Pulvinal Beclometasone Dipropionate) CFC-free beclomethasone inhalers are not interchangeable and should be prescribed by brand name. Clenil Modulite is probably the best buy for new prescriptions. dry powder inhaler 200micrograms/metered inhalation, 400micrograms/metered inhalation for patients who cannot take beclometasone, budesonide or fluticasone. 3.2 Corticosteroids 3.2 Mometasone Exceptional case tablets 20 mg For adults zafirlukast costs less than montelukast 3.03 Cromoglicate and related therapy and leukotriene receptor antagonists Zafirlukast 3.03 Cromoglicate and related therapy and leukotriene receptor antagonists Montelukast tablets 10mg; chewable tablets 4mg, 5mg granules 4mg 3.4 Antihistamines, hyposensitisation, and allergic emergencies Cetirizine tablets 10mg; oral solution sugar free 1mg/ml less sedating drug 3.4 Antihistamines, hyposensitisation, and allergic emergencies Loratadine tablets 10mg; syrup 5mg in 5ml less sedating drug 3.4 Antihistamines, hyposensitisation, and allergic emergencies 3.4 Antihistamines, hyposensitisation, and allergic emergencies Promethazine hydrochloride Hydroxyzine tablets 10mg, 25mg; elixir 5mg in 5ml tablets 10mg, 25mg syrup 10mg in 5ml 3.4 Antihistamines, hyposensitisation, and allergic emergencies Chlorphenamine tablets 4mg; syrup 2mg in 5ml; 3.4 Antihistamines, hyposensitisation, and allergic emergencies Adrenaline/ epinephrine pre-filled auto-injector delivering 150 micrograms (EpiPen Junior, Emerade, Jext), 300 micrograms (EpiPen, Emerade, Jext), 500 micrograms (Anapen 500, Emerade) Prescribe using the brand name

12 capsules 375mg; oral liquid 250mg in 5ml For use in line with NICE guidance 3.7 Mucolytics 3.7 Carbocisteine 3.7 Mucolytics 3.7 Dornase alfa 3.7 Mucolytics 3.7 Hypertonic sodium chloride nebuliser solution nebuliser solution 3%, 6%, 7% GPs should not be asked to prescribe this unless a local shared care protocol has been agreed. 3.8 Aromatic inhalations 3.8 Menthol and eucalyptus 3.9 Cough Pholcodine inhalation sugar-free linctus 5mg in 5ml See BNF for limited role 3.9 Cough Codeine linctus 15mg in 5ml See BNF for limited role 3.9 Cough Simple linctus, linctus paediatric See BNF for limited role 4.1 Hypnotics and anxiolytics Hypnotics Zaleplon capsules 5mg, 10mg When a short acting hypnotic is indicated NICE recommend the cheapest of short-acting benzodiazepine, zaleplon, zolpidem or zopiclone. Zolpidem and zopiclone are currently the lowest cost. 4.1 Hypnotics and anxiolytics Hypnotics Zopiclone tablets 3.75mg, 7.5mg When a short acting hypnotic is indicated NICE recommend the cheapest of short-acting benzodiazepine, zaleplon, zolpidem or zopiclone. Zolpidem and zopiclone are currently the lowest cost. 4.1 Hypnotics and anxiolytics Hypnotics Zolpidem tartrate tablets 5mg, 10 mg When a short acting hypnotic is indicated NICE recommend the cheapest of short-acting benzodiazepine, zaleplon, zolpidem or zopiclone. Zolpidem and zopiclone are currently the lowest cost. 4.1 Hypnotics and anxiolytics Hypnotics Temazepam tablets 10mg, 20mg; oral solution 10mg in 5ml When a short acting hypnotic is indicated NICE recommend the cheapest of short-acting benzodiazepine, zaleplon, zolpidem or zopiclone. Zolpidem and zopiclone are currently the lowest cost. 4.1 Hypnotics and anxiolytics Lorazepam tablets 1mg, 2.5mg 4.1 Hypnotics and anxiolytics Diazepam tablets 2mg, 5mg, 10mg; oral solution 2mg in 5ml. rectal tubes 2.5mg in 1.25ml, 5mg in 2.5ml, 10mg in 2.5ml capsules 5mg, 10mg 4.1 Hypnotics and anxiolytics Chlordiazepoxide 4.2 Drugs used in psychoses and 4.1 Hypnotics and anxiolytics Buspirone tablets 5mg, 10mg 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and Antipsychotic Trifluoperazine Antipsychotic Sulpiride Antipsychotic Quetiapine tablet 1mg, 5mg; oral solution 5mg in 5ml tablets 200mg, 400mg; oral solution 200mg in 5ml. tablets 25mg, 100mg 150mg, 200mg, 300mg; MR tablets 50mg, 200mg, 300mg, 400mg An NWL shared care document exists; see the shared care documents folder on this site.

13 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and Antipsychotic Olanzapine Antipsychotic Chlorpromazine hydrochloride Antipsychotic Aripiprazole Antipsychotic Amisulpride tablets 2.5mg, 5mg, 7.5mg, 10mg, 15mg; orodispersible tablets 5mg, 10mg, 15mg, 20mg tablets 10mg, 25mg, 50mg, 100mg; oral solution 25mg in 5ml, 100mg in 5ml tablets 5mg, 10mg, 15mg, 30mg; orodispersible tablets 10mg, 15mg oral tablets solution 50mg, 1mg 100mg, in 1ml 200mg, 400mg; oral solution 100mg in 1ml Orodispersible tablets cost more than standard tablets. An NWL shared care document exists; see the shared care documents folder on this site. An NWL shared care document exists; see the shared care documents folder on this site. An NWL shared care document exists; see the shared care documents folder on this site. 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and Antipsychotic Risperidone Antipsychotic Haloperidol tablets 500micrograms, 1mg, 2mg, 3mg, 4mg, 6mg, orodispersible tablets 500micrograms, capsules micrograms; 1mg, 2mg, tablets 1.5mg, 5mg, 10mg, 20mg; oral liquid 10mg in 5ml; injection 5mg in 1ml tablets 3mg Orodispersible tablets cost much more than standard tablets. An NWL shared care document exists; see the shared care documents folder on this site. 4.2 Drugs used in psychoses and Antipsychotic Flupentixol 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and Antipsychotic Zuclopenthixol tablets 2mg, 10mg, 25mg Antipsychotic Levomepromazine tablets 25mg,injection 25mg/ml Antipsychotic depot injections Antipsychotic depot injections Antipsychotic depot injections Antipsychotic depot injections Antipsychotic depot injections Antipsychotic depot injections Aripiprazole Flupentixol decanoate Fluphenazine decanoate Haloperidol (as decanoate) Paliperidone Pipotiazine palmitate depot injection 400mg depot injection 20mg/ml, 100mg/ml, 200mg/ml depot injection 25mg/ml, 100mg/ml depot injection 50mg/ml, 100mg/ml injection 50mg, 75mg, 100mg, 150mg depot injection 50mg/ml For use in palliative care An NWL shared care document exists; see the shared care documents folder on this site. An NWL shared care document exists; see the shared care documents folder on this site. 4.2 Drugs used in psychoses and Antipsychotic depot injections Risperidone depot injection 25mg, 37.5mg, 50mg An NWL shared care document exists; see the shared care documents folder on this site. 4.2 Drugs used in psychoses and Antipsychotic depot injections Zuclopenthixol decanoate depot injection 200mg/ml, 500mg/ml 4.2 Drugs used in psychoses and Antimanic Valproic acid e/c tablets 250mg, 500mg 4.2 Drugs used in psychoses and Antimanic Lithium citrate liquid 520mg in 5ml (Priadel ); oral solution 509mg in 5ml (Liliquid ); Prescribe by brand name. An NWL shared care document exists; see the shared care documents folder on this site. 4.2 Drugs used in psychoses and Antimanic Lithium carbonate MR tablets 200mg, 400mg (Priadel, Camcolit, Liskonum ) Prescribe by brand name. An NWL shared care document exists; see the shared care documents folder on this site

14 4.03 Antidepressant Tricyclic and related antidepressant Clomipramine capsules, 10mg, 25mg, 50mg 4.03 Antidepressant 4.03 Antidepressant Tricyclic and related antidepressant Tricyclic and related antidepressant Trazodone Lofepramine capsules 50mg, 100mg; tablets 150mg; liquid 50mg in 5ml tablets 70mg; oral suspension 70mg in 5ml Not a first line antidepressant Lower incidence of side effects and less dangerous in overdose than other tricyclic antidepressants, but infrequently associated with hepatic toxicity 4.03 Antidepressant Tricyclic and related antidepressant Imipramine tablets 10mg, 25mg 4.03 Antidepressant Tricyclic and related antidepressant Amitriptyline hydrochloride tablets 10mg, 25mg, 50mg; oral solution 25mg in 5ml, 50mg in 5ml 4.03 Antidepressant Tricyclic and related antidepressant Nortriptyline tablets 10mg, 25mg 4.03 Antidepressant Monoamine-oxidase inhibitors Moclobemide tablets 150mg 4.03 Antidepressant Monoamine-oxidase inhibitors Phenelzine tablets 15mg 4.03 Antidepressant 4.03 Antidepressant Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors Sertraline Fluoxetine tablets 50mg, 100mg capsules 20mg; liquid 20mg in 5ml dispersible tablets 20mg 4.03 Antidepressant Selective serotonin reuptake inhibitors Citalopram tablets 10mg, 20mg, 40mg; oral solution 40mg/ml sugar free 4.03 Antidepressant Selective serotonin reuptake inhibitors Paroxetine tablets 20mg, 30mg 4.03 Antidepressant Other antidepressant Duloxetine capsules 30mg, 60mg For use in neuropathic pain e.g. In palliative care. Not included in the Integrated Formulary for treatment of depression or generalised anxiety disorder Antidepressant Other antidepressant Venlafaxine tablets 37.5mg, 75mg; MR tablets 75mg, 150mg, 225 mg Plain tablets cost less than MR formulations. MR tablets cost much less than MR capsules Antidepressant Other antidepressant Mirtazapine tablets 15mg, 30mg, 45mg; Orodispersible (soluble) tablets 15mg, 30mg, 45mg 4.4 Central nervous system stimulants 4.4 Methylphenidate hydrochloride tablets 5mg, 10mg; MR capsules 10mg, 20mg, 30mg (Equasym XL); MR capsules 10mg, 20mg, 30mg, 40mg (Medikinet XL); MR tablets 18mg, 27mg, 36mg (Concerta XL ) Shared care documents are in use in some parts of NWL. Capsules, 10mg, 18mg, 25mg, 40mg, 60mg, 80mg Shared care documents are in use in some parts of NWL. 4.4 Central nervous system stimulants 4.4 Atomoxetine

15 4.4 Central nervous system stimulants 4.4 Dexamfetamine sulphate tablets 5mg Use for ADHD is listed in the BNF but is unlicensed. Shared care documents are in use in some parts of NWL. 4.4 Central nervous system stimulants Drugs used in the treatment of obesity Lisdexamfetamine mesilate 4.4 Central nervous system stimulants 4.4 Modafinil Orlistat 4.6 Drugs used in nausea and vertigo 4.6 Prochlorperazine capsules 30mg, 50mg, 70mg tablets capsules 120mg tablets 5mg, buccal tablets 3mg; syrup 5mg in 5ml NICE: Prescribe only as part of an overall plan for managing obesity in adults who have: 4.6 Drugs used in nausea and vertigo 4.6 Metoclopramide 4.6 Drugs used in nausea and vertigo 4.6 Domperidone 4.6 Drugs used in nausea and vertigo 4.6 Cyclizine tablets 10mg; oral solution 5mg in 5ml; injection 10mg in 2ml tablets 10mg; suspension 5mg in 5ml; suppositories 30mg tablets 50 mg; injection 50mg in 1ml 4.6 Drugs used in nausea and vertigo Drugs used in nausea and vertigo 4.6 Hyoscine hydrobromide Betahistine dihydrochloride 4.6 Drugs used in nausea and vertigo 4.6 Ondansetron 4.7 Analgesics 4.7 Analgesics Non-opioid analgesics and compound analgesic Non-opioid analgesics and compound analgesic Paracetamol Co-dydramol tablets 300micrograms tablets 8mg 16mg tablets 4mg, 8mg; oral solution4mg/5ml; injection 2mg/ml tablets 500mg; dispersible tablets 500mg; oral suspension sugar free 120mg tablets 10/500 in 5ml, 250mg in 5ml For hypersalivation associated with clozapine therapy [unlicensed indication] Suppositories cost much more than tablets and liquids 4.7 Analgesics Non-opioid analgesics and compound analgesic Co-codamol tablets 8/500, 30/500; dispersible tablets 8/500, 30/500 Dispersible tablets cost more than plain tablets 4.7 Analgesics Non-opioid analgesics and compound analgesic Aspirin dispersible tablets 300mg 4.7 Analgesics Non-opioid analgesics and compound analgesic Nefopam tablets 30mg 4.7 Analgesics Opioid analgesics Fentanyl buccal tablets 100micrograms, 200micrograms, 400micrograms, 600micrograms, 800micrograms; nasal spray (PecFent) 100micrograms/spray, 400micrograms/spray; patches 12mcg, 25mcg, 37.5mcg, 50mcg, 75mcg and 100mcg/hour all for 72 hours Buccal tablets and nasal spray are only included for use in palliative care. Mezolar is currently the only brand available in the 37.5mcg/hr strength.

16 4.7 Analgesics Opioid analgesics Morphine sulphate 4.7 Analgesics Opioid analgesics Diamorphine tablets (Sevredol ) 10mg, 20mg, 50mg ; MR tablets (Morphgesic SR ) 10mg, 30mg, 60mg, 100mg; MR capsules (Zomorph ) 10mg, 30mg, 60mg, 100mg, 200mg ; MR capsules (MXL ) 30mg, 60mg, 90mg, 120mg, 150mg, 200mg ; MR tablets (MST ) 5mg; oral solution 10mg in 5ml, 100mg in 5ml; MR suspension 20mg/sachet, injection 5mg, 10mg, 30mg, 100mg, 500mg oral strong opioid. Reserve MR suspension sachets for people who cannot take MR tablets 4.7 Analgesics Opioid analgesics Methadone 4.7 Analgesics Opioid analgesics Oxycodone 4.7 Analgesics Opioid analgesics Tapentadol tablets 5mg; injection 10mg/ml capsules 5mg, 10mg, 20mg; MR tablets 5mg, 10mg, 20mg, 50mg, 75mg; MR tablets 50mg, 100mg, 150mg, 200mg, 250mg For use in palliative care. strong opioid Included in the IF for restricted use: it should be initiated in secondary care and only used in line with the protocol approved by that hospital's New Drugs Panel or equivalent. 4.7 Analgesics Opioid analgesics Tramadol hydrochloride Capsule 50mg MR tablets 100mg, 150mg, 200mg. MR capsules, 50mg, 100mg, 150mg, 200mg Marol appears to be the cheapest brand of modified release 12 hourly tramadol listed in the BNF. tablets 30 mg 4.7 Analgesics Opioid analgesics Dihydrocodeine 4.7 Analgesics Opioid analgesics Codeine phosphate Tablets codeine phosphate 15 mg, 30 mg, 60 mg 4.7 Analgesics Opioid analgesics Buprenorphine patches '5' patch (releasing 5 micrograms/hour for 7 days), '10' patch (releasing 10 micrograms/hour for 7 days), '20' patch (releasing 20 micrograms/hour for 7 days); patch 35 micrograms/hour, 52.5 micrograms per hour; 70 micrograms per hour all for 96 hours; sublingual tablets 200micrograms, 400micrograms tablets 50mg, 100mg; injection pre-filled syringe and refill pack 6mg in 0.5ml; nasal spray 10mg in 0.1ml, 20mg in 0.1ml Treatment of acute migraine 4.7 Analgesics Antimigraine Sumatriptan

17 4.7 Analgesics Antimigraine Zolmitriptan orodispersible tablets 2.5mg, 5mg Treatment of acute migraine 4.7 Analgesics Antimigraine Pizotifen 4.7 Analgesics Antimigraine Naratriptan tablets 500 micrograms, 1.5 mg tablets 2.5mg Prophylaxis of migraine. Of limited value and may cause weight gain (BNF). Beta-blockers, tricyclic antidepressants and some other Treatment of acute migraine 4.7 Analgesics Antimigraine Almotriptan tablets 12.5mg Treatment of acute migraine 4.8 Antiepileptics Vigabatrin tablets 500mg; powder 500mg/sachet 4.8 Antiepileptics Topiramate tablets 25mg, 50mg, 100mg, 200mg; sprinkle capsules 15mg, 25mg, 50mg 4.8 Antiepileptics Tiagabine tablets 5mg, 10mg, 15mg 4.8 Antiepileptics Sodium valproate ec tablets 200mg, 500mg; MR tablets 200mg, 300mg, tablet 250 mg 4.8 Antiepileptics Primidone 4.8 Antiepileptics Pregabalin capsules 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg For use in line with NICE's guidance 4.8 Antiepileptics Phenytoin capsules phenytoin sodium 25mg, 50mg, 100mg, 300mg; tablets phenytoin sodium 100mg; chewable tablets phenytoin 50mg; suspension phenytoin 30mg in 5ml tablets 15mg, 30mg, 60mg; elixir 15mg/5ml 4.8 Antiepileptics Phenobarbital 4.8 Antiepileptics Oxcarbazepine 4.8 Antiepileptics Levetiracetam tablets 150mg, 300mg, 600mg; oral suspension 300mg in 5ml. tablets 250mg, 500mg, 750mg, 1g; oral liquid 500mg in 5ml;

18 4.8 Antiepileptics Lamotrigine 4.8 Antiepileptics Perampanel 4.8 Antiepileptics Gabapentin tablets 25mg, 50mg, 100mg, 200mg; dispersible tablets 5mg, 25mg, 100mg tablets 2mg, 4mg,6mg, 8mg, 10mg, 12mg capsules 100mg, 300mg, 400mg. Tablets 600mg 4.8 Antiepileptics Ethosuximide capsules 250 mg 4.8 Antiepileptics Clonazepam 4.8 Antiepileptics Clobazam 4.8 Antiepileptics Carbamazepine tablet 500micrograms tablets 10mg; tablets 100mg, 200mg, 400mg; MR tablets 200mg, 400mg; tablets chewable 100mg, 200mg; liquid 100mg in 5ml 4.8 Antiepileptics Retigabine tablets 50mg, 100mg, 200mg, 300mg, 400mg; starter pack 4.8 Antiepileptics Lacosamide tablets 50mg, 100mg, 150mg, 200mg; Syrup, 50mg in 5ml. 4.8 Antiepileptics Zonisamide capsules 25mg, 50mg, 100mg 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and Selegiline Rotigotine tablets 1.25mg, 5mg, 10mg; oral liquid 10mg in 5ml patches 2mg/24hr, 4mg/24hr, 6mg/24hr, 8mg/24hr 4.9 Drugs used in parkinsonism and Ropinirole tablets 250microgram, 500micrograms, 1mg, 2mg, 5mg; MR tablet tablets 1 mg 2mg, 4mg, 8mg; 4.9 Drugs used in parkinsonism and Rasagiline mesilate 4.9 Drugs used in parkinsonism and Pramipexole tablets 88microgram, 180micrograms, 350micrograms, 700micrograms; MR tablets 260micrograms, 520micrograms, 1.05mg, 1.57mg, 2.1mg, 2.62mg, 3.15mg tablets 200mg 4.9 Drugs used in parkinsonism and Entacapone

19 4.9 Drugs used in parkinsonism and Co-careldopa tablets 12.5/50, contain levodopa 50mg and carbidopa 12.5mg (Sinemet 62.5 ); tablets 10/100, contain levodopa 100mg and carbidopa 10mg; tablets 25/250, contain levodopa 250mg and carbidopa 25mg; tablets 25/100, contain levodopa 100mg and carbidopa 25mg; tablets 25/100, modifiedrelease, contain levodopa 100mg and carbidopa 25mg (Half Sinemet CR ). tablets 50/200, modifiedrelease, contain levodopa 200mg and carbidopa 50mg (Sinemet CR ); 4.9 Drugs used in parkinsonism and Co-beneldopa capsules 12.5/50 contain levodopa 50mg and benserazide 12.5mg; 25/100 contain levodopa 100mg and benserazide 25mg; 50/200 contain levodopa 200mg and benserazide 50mg; dispersible tablets 12.5/50, 25/100; MR capsules 25/100 (Madopar CR ) contain levodopa 100mg and benserazide 25mg 4.9 Drugs used in parkinsonism and Stalevo tablets 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and Amantadine Trihexyphenidyl Procyclidine capsules 100mg tablets 2mg, 5mg; syrup 5mg in 5ml tablets 5mg; sugar free syrup 2.5mg in 5ml, 5mg in 5ml 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and Drugs used in essential tremor, chorea, tics, and Drugs used in essential tremor, chorea, tics, and Orphenadrine hydrochloride Riluzole Tetrabenazine tablet 50 mg tablets 50mg tablets 25mg For use in line with NICE's guidance. GPs should only be asked to prescribe this if a local shared care protocol has been agreed Drugs used in substance dependence Alcohol dependence Acamprosate Calcium tablet 333 mg

20 4.10 Drugs used in substance dependence Alcohol dependence Disulfiram tablets 200mg 4.10 Drugs used in substance dependence 4.10 Drugs used in substance dependence Alcohol dependence Nalmefene Nicotine dependence Varenicline tablets 18mg Tablets, f/c, varenicline (as tartrate) 500 micrograms, 1 mg In line with NICE TA325. Note MHRA/CHM advice on association with psychiatric symptoms including suicidal thoughts Drugs used in substance dependence Nicotine dependence Nicotine patches (all strengths); chewing gum 2mg, 4mg; sublingual tablet 2mg; lozenge 1mg, 2mg, 4mg; inhalation 10mg; nasal spray In line with local smoking cessation service protocols 4.10 Drugs used in substance dependence Opioid dependence Methadone sugar-free oral solution 1mg in 1ml 4.10 Drugs used in substance dependence Opioid dependence Buprenorphine + naloxone Suboxone 2mg/500micrograms; 8mg/2mg sublingual tablets 4.10 Drugs used in substance dependence Opioid dependence Buprenorphine sublingual tablets 400micrograms, 2mg, 8mg 4.10 Drugs used in substance dependence Opioid dependence Naltrexone 4.11 Drugs used for dementia 4.11 Rivastigmine tablets 50mg capsules 1.5mg, 3mg, 4.5mg, 6mg; oral solution 2mg/ml; patches 4.6mg/24 hours, 9.5mg/24 hours Only for use in line with NICE's guidance. Shared care documents have been agreed in some parts of NWL and in these areas GPs should only be asked to prescribe the drug in line with the agreement Drugs used for dementia 4.11 Memantine tablets 10mg, 20mg; treatment initiation pack; oral solution 5mg/actuation Only for use in line with NICE's guidance. Shared care documents have been agreed in some parts of NWL and in these areas GPs should only be asked to prescribe the drug in line with the agreement Drugs used for dementia 4.11 Galantamine 4.11 Drugs used for dementia 4.11 Donepezil tablets 8mg, 12mg; MR capsules 8mg, 16mg, 24mg oral solution 4mg in 1ml tablets 5mg, 10mg Only for use in line with NICE's guidance. Shared care documents have been agreed in some parts of NWL and in these areas GPs should only be asked to prescribe the drug in line with the agreement. Only for use in line with NICE's guidance. Shared care documents have been agreed in some parts of NWL and in these areas GPs should only be asked to prescribe the drug in line with the agreement. 5.1 Antibacterial Penicillins Phenoxymethylpenic illin (penicillin V) tablets 250mg; sugar-free oral solution 125mg in 5ml, 250mg in 5ml Refer to local anti-bacterial guidelines 5.1 Antibacterial Penicillins Flucloxacillin capsules 250mg, 500mg; sugar-free oral solution 125mg in 5ml, 250mg in 5ml Flucloxacillin liquid is currently expensive. Refer to local anti-bacterial guidelines 5.1 Antibacterial Penicillins Co-amoxiclav Tablets 375mg (amoxicillin 250mg and clavulanic acid 125mg); 625mg (amoxicillin 500mg and clavulanic acid 125mg); suspension 125/31 in 5ml, 250/62 in 5ml, 400/57 in 5ml Refer to local anti-bacterial guidelines