West London Mental Health NHS Trust Formulary

Transcription

1 West London Mental Health NHS Trust Formulary VERSION 7.0 ( ) The Formulary is a list of medicines used for mental health indications for patients cared for in all settings of West London Mental Health NHS Trust. The Formulary is intended to cover prescribing in Mental Health Conditions and the Management of adverse effects related to the medication for: prescriptions written for inpatients; prescriptions or recommendations by Trust doctors in respect of outpatients or patients leaving hospital after an admission. The evidence base for the formulary has been based on the Maudsley Prescribing Guidelines. The Formulary 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. Prescribing outside of the formulary will require a discussion with the Team pharmacist before the medication can be ordered by pharmacy and clinicians should be aware that items will not be kept in pharmacy and there may be a delay in supply. People currently receiving a medicine that is not included in the Formulary should have the option to continue until they and their clinicians consider it appropriate to stop. Mental Health medicines recommended by NICE technology appraisal guidance (TAG) will, where clinically appropriate, be included in the Formulary within 90 days of the date the TAG is published. initiation A number of medicines in the Formulary are marked specialist initiation by NWL. The medicine should initially be prescribed by a mental health specialist 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, however it is reasonable for a GP to write the first prescription after a telephone conversation with a mental health specialist clinician if the medication is included in the NWL integrated formulary. 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. Hospital Only Medicines (Red List) Medicines marked as Hospital Only should only be prescribed by Trust Clinicians and should not be referred to primary care for prescribing Medicines Not included in the NWL Integrated Formulary The NWL IF has been developed to co-ordinate prescribing across the primary/secondary care setting throughout NWL. However it is recognised that medicines may be initiated in hospital which are not covered by the NWL IF. In these cases the Trust doctor must provide clear rationale to the GP for prescribing, including why medicines on the IF are not appropriate. Physical Health Prescribing Prescribing for physical health medications should be in line with the North West London integrated formulary (NWL IF), and, where possible be a medication stocked by the Trust pharmacy department. Minor Ailment Medication Although these have not been included in the mental health formulary, a list of medicines from the NWL IF stocked in pharmacy for nausea and vomitting, infections and analgesia have been included as a seperate list to assist prescribers decision making in these areas. BNF chapter BNF section BNF sub-section 2. Cardiovascular system 2.4 Beta-adrenoceptor blocking drugs 2.4 Bisoprolol For use in clozapine induced Tachycardia 2. Cardiovascular system 2. Cardiovascular system 2.4 Beta-adrenoceptor blocking drugs 2.4 Propranolol 2.12 Lipid-regulating drugs Other Omacor (omega-3 acid ethyl esters) MR capsules capsules (Omacor and Maxepa). For use as an anxiolytic or for the management of akathesia Treatment resistant psychosis (off-label not on Trust approved list) Maxepa is considerably cheaper 3. Respiratory system 3.4 Antihistamines, hyposensitisation, and allergic emergencies Promethazine elixir injection Licensed Indication Insomnia Injection reserved for RT (off-label) (, elixir) 1 of 13

2 BNF chapter BNF section BNF sub-section 4.1 Hypnotics and anxiolytics Hypnotics Zopiclone 4.1 Hypnotics and anxiolytics Hypnotics Zolpidem tartrate 4.1 Hypnotics and anxiolytics Hypnotics Temazepam 4.1 Hypnotics and anxiolytics Lorazepam 4.1 Hypnotics and anxiolytics Diazepam injection rectal tubes Diazemul injection 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 drugs. 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 drugs. 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 drugs. () Diazemul Injection reserved for RT (Tablets,, rectal tubes) 4.1 Hypnotics and anxiolytics Chlordiazepoxide capsules 4.1 Hypnotics and anxiolytics Buspirone Antipsychotic drugs Trifluoperazine Antipsychotic drugs Sulpiride Antipsychotic drugs Quetiapine Antipsychotic drugs Olanzapine Antipsychotic drugs Chlorpromazine Antipsychotic drugs Aripiprazole Antipsychotic drugs Amisulpride Antipsychotic drugs Clozapine Antipsychotic drugs Risperidone Antipsychotic drugs Haloperidol Antipsychotic drugs Flupentixol Antipsychotic drugs Zuclopenthixol Aripiprazole Flupentixol decanoate tablet tablet MR orodispersible Orodispersible cost more than standard (Tablets, orodispersible) injection orodispersible liquid (unlicensed) orodispersible capsules oral liquid Injection Long Acting Injection depot injection Consultant (Hospital Only) NO - RED LIST Orodispersible cost much more than standard Injection reserved for RT (capsules,, oral liquid) First generation antipsychotic depots should be considered first line treatment option evidence of this is requiredaripiprazole LAI should only be used in patients who have responded to oral aripiprazole (4-6 weeks). If having to use more than one vial the same strength vials should be used to ensure the correct dose is received. It is recommended that the smallest volume is used for depot administration and in general should not exceed 2mls. 2 of 13

3 BNF chapter BNF section BNF sub-section Drugs used for mania and hypomania Drugs used for mania and hypomania Drugs used for mania and hypomania Drugs used for mania and hypomania Monoamine-oxidase inhibitors Fluphenazine decanoate Haloperidol (as decanoate) Olanzapine Paliperidone Pipotiazine palmitate Risperidone Zuclopenthixol decanoate Valproic acid Lithium citrate Lithium carbonate Asenapine Clomipramine Trazodone Lofepramine Imipramine Amitriptyline Mianserin Nortriptyline Moclobemide depot injection depot injection Long Acting Injection Long Acting Injection Monthly Long Acting Injection 3 Monthly depot injection Long Acting Injection depot injection E/C Tablets liquid (Priadel ) (Li-liquid ); (Camcolit,) MR (Priadel, Camcolit, Liskonum ) sublingual capsules capsules liquid oral suspension Consultant Only (with Clinical Director Approval outisde of HSS) If having to use more than one vial the same strength vials should be used to ensure the correct dose is received. It is recommended that the smallest volume is used for depot administration and in general should not exceed 2mls. If having to use more than one vial the same strength vials should be used to ensure the correct dose is received. It is recommended that the smallest volume is used for depot administration and in general should not exceed 2mls. Olanzapine LA is only approved for use in High Secure Cervices. In other areas there is a process for assessing individual cases. In Line with Trust guidance on use of long acting antipsychotics and I17p Initiating and reviewing Long Acting Injections and Depot Antipsychotic Medication ( Local services) It is recommended that the smallest volume is used for depot administration and in general should not exceed 2mls. If having to use more than one vial the same strength vials should be used to ensure the correct dose is received. It is recommended that the smallest volume is used for depot administration and in general should not exceed 2mls. Prescribe by brand name Prescribe by brand name 3rd line use for mania Lower incidence of side effects and less dangerous in overdose than other tricyclic antidepressants, but infrequently associated with hepatic toxicity 3 of 13

4 BNF chapter BNF section BNF sub-section Monoamine-oxidase inhibitors Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors Phenelzine Sertraline Fluoxetine Citalopram Consultant only capsules liquid Selective serotonin reuptake inhibitors Paroxetine Paroxetine has a short half life and has been associated with more withdrawal effects than other SSRI's Other antidepressant drugs Other antidepressant drugs Other antidepressant drugs Other antidepressant drugs Venlafaxine Mirtazapine Agomelatine Vortioxetine MR Orodispersible (soluble) Consultant Only In primary care Ordinary release cost less than MR which cost much less than MR capsules. 4.4 Central nervous system stimulants 4.4 Methylphenidate 5mg, 10mg; MR capsules 10mg, 20mg, 30mg (Equasym XL); MR capsules 10mg, 20mg, 30mg, 40mg (Medikinet XL); MR 18mg, 27mg, 36mg (Concerta XL ) Prescribe by Brand Shared care documents are in use in some parts of NWL. 4.4 Central nervous system stimulants 4.4 Atomoxetine Capsules Shared care documents are in use in some parts of NWL. 4.4 Central nervous system stimulants 4.4 Dexamfetamine sulphate 4.4 Central nervous system stimulants 4.4 Lisdexamfetamine CAMHS 4.4 Central nervous system stimulants 4.4 Modafinil Shared care documents are in use in some parts of NWL. For use when response to previous methylphenidate treatment is considered clinically inadequate. 4.8 Antiepileptics Topiramate 4.8 Antiepileptics Sodium valproate ec MR crushable liquid (sugar-free) Mood stabiliser and to reduce the risk of fitting for patients on clozapine > 600mg/d (off-label Trust approved) 4.8 Antiepileptics Pregabalin capsules For use in line with NICE's guidance 4.8 Antiepileptics Lamotrigine 4.8 Antiepileptics Clonazepam 25mg, 50mg, 100mg, 200mg; dispersible 5mg, 25mg, 100mg tablet 500micrograms, 2mg; injection Anxiety and Agitation (off-label Trust approved) 4 of 13

5 BNF chapter BNF section BNF sub-section 4.8 Antiepileptics Carbamazepine 100mg, 200mg, 400mg; MR 200mg, 400mg; chewable 100mg, 200mg; liquid 100mg in 5ml 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and 4.10 Drugs used in substance 4.10 Drugs used in substance 4.10 Drugs used in substance 4.10 Drugs used in substance 4.10 Drugs used in substance 4.10 Drugs used in substance 4.10 Drugs used in substance 4.10 Drugs used in substance 4.10 Drugs used in substance 4.10 Drugs used in substance Trihexyphenidyl Procyclidine Orphenadrine Alcohol Disulfiram Alcohol Acamprosate Calcium Alcohol Nalmefene Nicotine Nicotine Nicotine Buproprion Nicotine Varenicline Opioid Methadone Opioid Buprenorphine + naloxone Opioid Buprenorphine Opioid Naltrexone 4.11 Drugs used for dementia 4.11 Rivastigmine 4.11 Drugs used for dementia 4.11 Memantine 4.11 Drugs used for dementia 4.11 Galantamine syrup sugar free syrup tablet tablet tablet tablet patches (all strengths); chewing gum 2mg, 4mg; sublingual tablet 2mg; lozenge 1mg, 2mg, 4mg; inhalation 10mg; nasal spray; oral spray; oral strips Tablets, f/c, varenicline (as tartrate) 500 micrograms, 1 mg sugar-free 1mg in 1ml Suboxone 2mg/500micrograms; 8mg/2mg sublingual sublingual 400micrograms, 2mg, 8mg 50mg capsules 1.5mg, 3mg, 4.5mg, 6mg; 2mg/ml; patches 4.6mg/24 hours, 9.5mg/24 hours 10mg, 20mg; treatment initiation pack; 5mg/actuation 8mg, 12mg; MR capsules 8mg, 16mg, 24mg 4mg in 1ml In line with NICE TA - See Trust Guidance initiated by, or on the written advice of, the Bipolar Affective Disorder Tertiary Referral Clinic Bipolar Affective Disorder (off-label Trust approved) Use in line with Trust Smoking Cessation Guideline. For outpatients refer to local smoking cessation services. Caution oral spray contains alcohol. Note MHRA/CHM advice on association with psychiatric symptoms including suicidal thoughts. Use in line with Trust Smoking Cessation Guideline. For outpatients refer to local smoking cessation services. 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. 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 of 13

6 BNF chapter BNF section BNF sub-section 4.11 Drugs used for dementia 4.11 Donepezil Oestrogens and HRT Estradot 5mg, 10mg 25 patch, 37.5 patch, 50 patch, 75 patch, 100 patch 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. Oestrogen supplementation for recommendation by GIC (Off-label) Oestrogens and HRT Progynova Progynova 1mg ; Progynova 2mg Oestrogen supplementation for recommendation by GIC (Off-label) - provides more reliable levels than oestradiol hemihydrate Oestrogens and HRT Premarin 300micrograms, 625micrograms, 1.25mg Oestrogen supplementation for recommendation by GIC (Off-label) Oestrogens and HRT Sandrena Gel 0.1% 1mg/1g sachet Oestrogen supplementation for recommendation by GIC (Off-label) provides better and more reliable levels than oestrogel Oestrogens and HRT Ethinylestradiol Oestrogen supplementation for recommendation by GIC (Off-label) Male sex hormones and antagonists Testosterone Undeconate Injection Testosterone Supplementation for recommendation by GIC (Off-label) 5mg Male sex hormones and antagonists Finasteride Off-label use for recommendation by GIC Tablets Male sex hormones and antagonists Cyproterone acetate Licensed indication Control of libido in severe hypersexuality and/or sexual deviation in the adult male 6.5 Hypothalamic and pituitary hormones and anti-oestrogens Desmopressin Severe nocturnal enuresis due to clozapine when other measures have not been effective 6.7 Other endocrine drugs Bromocriptine Dopamine agonist - Maudsley recommended as a possible third line treatment for hyperprolactinaemia however may worsen psychosis and other preferable options are available 6.7 Other endocrine drugs Triptorelin 6.7 Other endocrine drugs Goserelin injection implant 10.8mg syringe N by GIC/Consultant only N by GIC/Consultant only Suppression of testosterone or to augment response to oestrogens for recommendation by GIC and treatment of hypersexuality (Off-label) Suppression of testosterone or to augment response to oestrogens for recommendation by GIC and treatment of hypersexuality (Off-label) 6 of 13

7 BNF chapter BNF section BNF sub-section 7. Obstetrics, gynaecology, and urinary-tract disorders 7.4 Drugs for genito-urinary disorders Drugs for erectile dysfunction Sildenafil See BNF for circumstances under which this can be prescribed on the NHS. Will be available generically sooner than similar drugs. 9. Nutrition and blood 9. Nutrition and blood 9. Nutrition and blood 9. Nutrition and blood 9.6 Vitamins Vitamin D 9.6 Vitamins Vitamin D Ergocalciferol (calciferol, vitamin D2) Colecalciferol (Cholecalciferol, vitamin D3) 9.6 Vitamins Vitamin D Calceos 9.6 Vitamins Vitamin D Adcal-D3 injection capsules 800 units, 3200 units (Fultium ), 20,000 units (Aviticol); Valupak 1,000 units (nutritional product) chewable, contain 12.5mmol calcium and 400 units colecalciferol (chewable), calcium carbonate 1.5g (calcium 600mg/15mmol), colecalciferol 10 micrograms (400 units) Availability of this UK licensed product is sporadic. Refer to local guidance on vitamin D. Also refer to local guidance on vitamin D products. 10. Musculoskeletal and joint diseases 10. Musculoskeletal and joint diseases 15. Anaesthesia 10.1 Drugs used in rheumatic disease and gout 10.2 Drugs used in neuromuscular disorders Gout and cytotoxicinduced hyperuricaemia Skeletal muscle relaxants Allopurinol Baclofen 15.1 General anaesthesia Benzodiazepines Midazolam 10mg; 5mg in 5ml injection 1mg/ml 5ml ampoules Consultant Initiation for TRS/MANIA Mausdley guidelines recommendation for TRS refractory to clozapine and in addition to lithium in mania TD For use when IM Lorazepam unavailable for RT For use in palliative care 15. Anaesthesia 15.1 General anaesthesia 15.1 General anaesthesia Antagonists for central and respiratory depression Antagonists for central and respiratory depression Naloxone Flumazenil injection 400micrograms in 1ml injection 100micrograms/ml 5ml ampoules Ensure that flumazenil is available where injectable benzodiazepines are used. 7 of 13

8 Mental Health NICE Technology Appraisals Technology Appraisal Medicines Guidance TA77 TA98 TA213 Zaleplon Zolpidem Zopicole Methylphenidate Atomoxetine Dexamfetamine Aripiprazole It is recommended that, because of the lack of compelling evidence to distinguish between zaleplon, zolpidem, zopiclone or the shorteracting benzodiazepine hypnotics, the drug with the lowest purchase cost (taking into account daily required dose and product price per dose) should be prescribed. It is recommended that switching from one of these hypnotics to another should only occur if a patient experiences adverse effects considered to be directly related to a specific agent. These are the only circumstances in which the drugs with the higher acquisition costs are recommended. Patients who have not responded to one of these hypnotic drugs should not be prescribed any of the others. Where drug treatment is considered appropriate, methylphenidate, atomoxetine and dexamfetamine are recommended, within their licensed indications, as options for the management of ADHD in children and adolescents. Aripiprazole is recommended as an option for the treatment of schizophrenia in people aged 15 to 17 years who are intolerant of risperidone, or for whom risperidone is contraindicated, or whose schizophrenia has not been adequately controlled with risperidone. TA217 Donepezil Galantamine Rivastigmine Memantine 1. The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine are recommended as options for managing mild to moderate Alzheimer s disease under all of the conditions specified in 3 and Memantine is recommended as an option for managing Alzheimer s disease for people with: moderate Alzheimer s disease who are intolerant of or have a contraindication to AChE inhibitors or severe Alzheimer s disease. Treatment should be under the conditions specified in Treatment should be under the following conditions: Only specialists in the care of patients with dementia (that is, psychiatrists including those specialising in learning disability, neurologists, and physicians specialising in the care of older people) should initiate treatment. Carers views on the patient s condition at baseline should be sought. Treatment should be continued only when it is considered to be having a worthwhile effect on cognitive, global, functional or behavioural symptoms. Patients who continue on treatment should be reviewed regularly using cognitive, global, functional and behavioural assessment. Treatment should be reviewed by an appropriate specialist team, unless there are locally agreed protocols for shared care. Carers views on the patient s condition at follow-up should be sought. 4. If prescribing an AChE inhibitor (donepezil, galantamine or rivastigmine), treatment should normally be started with the drug with the lowest acquisition cost (taking into account required daily dose and the price per dose once shared care has started). However, an alternative AChE inhibitor could be prescribed if it is considered appropriate when taking into account adverse event profile, expectations about adherence, medical comorbidity, possibility of drug interactions and dosing profiles.

9 Technology Appraisal Medicines Guidance TA292 Ariprazole Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder.aripiprazole is recommended as an option for treating moderate to severemanic episodes in adolescents with bipolar I disorder, within its marketingauthorisation (that is, up to 12 weeks of treatment for moderate to severemanic episodes in bipolar I disorder in adolescents aged 13 and older). TA325 Nalmefene Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol : who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40 g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and who do not require immediate detoxification. The marketing authorisation states that nalmefene should: only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment. Vortioxetine is recommended as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episode. People whose treatment with vortioxetine is not recommended in this NICE guidance, but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop. TA367 Vortioxetine

10 BNF Category Stocked in Pharmacy NWL IF Notes 4.6 Drugs used in nausea and vertigo Domperidone 4.6 Drugs used in nausea and vertigo Cyclizine Non-opioid analgesics and compound analgesic preparations Paracetamol Non-opioid analgesics and compound analgesic preparations Co-dydramol Non-opioid analgesics and compound analgesic preparations Co-codamol Non-opioid analgesics and compound analgesic preparations Aspirin Non-opioid analgesics and compound analgesic preparations Nefopam Opioid analgesics Fentanyl Morphine Opioid analgesics sulphate Opioid analgesics Oxycodone Tramadol Opioid analgesics Metoclopramide is not recommended as this crosses the blood brain barrier and can cause EPSE Opioid analgesics Dihydrocodeine Opioid analgesics Codeine phosphate Opioid analgesics Buprenorphine Phenoxymethylpe 5.1 Antibacterial drugs nicillin (penicillin V)

11 BNF Category Stocked in Pharmacy NWL IF Notes 5.1 Antibacterial drugs Flucloxacillin 5.1 Antibacterial drugs Co-amoxiclav 5.1 Antibacterial drugs Amoxicillin Cefalexin 5.1 Antibacterial drugs (cephalexin) 5.1 Antibacterial drugs Oxytetracycline 5.1 Antibacterial drugs Lymecycline 5.1 Antibacterial drugs Doxycycline 5.1 Antibacterial drugs Demeclocycline 5.1 Antibacterial drugs Erythromycin 5.1 Antibacterial drugs Clarithromycin 5.1 Antibacterial drugs Azithromycin 5.1 Antibacterial drugs Clindamycin 5.1 Antibacterial drugs Trimethoprim 5.1 Antibacterial drugs Metronidazole 5.1 Antibacterial drugs Ciprofloxacin 5.1 Antibacterial drugs Moxifloxacin 5.1 Antibacterial drugs Ofloxacin 5.1 Antibacterial drugs Nitrofurantoin 5.2 Antifungal drugs Terbinafine 5.2 Antifungal drugs Nystatin 5.2 Antifungal drugs Itraconazole 5.2 Antifungal drugs Fluconazole 5.3 Antiviral drugs Aciclovir

12 BNF Category Stocked in Pharmacy NWL IF Notes 5.3 Antiviral drugs Oseltamivir Non-steroidal anti-inflammatory drugs Ibuprofen Non-steroidal anti-inflammatory drugs Naproxen Non-steroidal anti-inflammatory drugs Celecoxib initiation 11.3 Anti-infective eye preparations Chloramphenicol Eye Drops 11.3 Anti-infective eye preparations Fusidic acid Gel 11.8 Miscellaneous ophthalmic preparations (Dry Eye) Hypromellose 11.8 Miscellaneous ophthalmic preparations (Dry Eye) Carmellose 11.8 Miscellaneous ophthalmic preparations (Dry Eye) Carbomer 980 (viscotears) Otitis externa Sofradex Otitis externa Otomize Locorten-Vioform Otitis externa Otitis externa Gentisone HC Clotrimazole Removal of ear wax Sodium bicarbonate Removal of ear wax Olive oil

13 Version Date released Amendments Amended by /03/2013 Formulary 1st release Michele Sie /02/2014 Update following addition of two new medicines approved by DTC Michele Sie /02/2015 Update following publication of TA for Nalmefene Michele Sie /02/2016 Update following publication of TA for Vortioxetine Michele Sie /04/2016 Update following DTC re Olanzapine LAI Michele Sie /05/2016 Update following addition of two new medicines approved by DTC Michele Sie /11/2016 Update following addition of one medicines approved by DTC Michele Sie