North West London Integrated Formulary

North West London Integrated Formulary PUBLISHED VERSION (v15 02.04.2015) 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 (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 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 initiation annotation may lie anywhere in a spectrum between: 1. The medicine should be prescribed by a relevant 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 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 initiation annotations say nothing about who is or is not a relevant in respect of a medicine. It will be reasonable for some of these medicines to be initiated by prescribers from more than one speciality. 1.1 Dyspepsia and gastro-oesophageal reflux disease 1.1.1 Antacids and simeticone Co-magaldrox (prescribe Mucogel) co-magaldrox 195/220 suspension Low sodium. Mucogel costs less than Maalox. 1.1 Dyspepsia and gastro-oesophageal reflux disease 1.1.1 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 1.1.1 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 1.1.2 Compound alginates Peptac 1.1.2 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 of 50

1.1 Dyspepsia and gastro-oesophageal reflux disease 1.2 Antispasmodics and other drugs altering gastric motility 1.2 Antispasmodics and other drugs altering gastric motility 1.2 Antispasmodics and other drugs altering gastric motility 1.3 Anti-secretory drugs and mucosal protectants 1.1.2 Compound alginates Gaviscon Infant oral powder; 1.2 1.2 1.2 1.3.1 H2- receptor antagonists Mebeverine hydrochloride Peppermint oil (prescribe Mintec) Hyoscine butylbromide Ranitidine tablets 135 mg e/c capsules 0.2ml tablets 10mg; injection 20mg in 1ml tablets 150mg, 300mg; effervescent tablets 150mg; oral solution 75mg in 5ml Contains alginate and 0.92mmol sodium /dose. 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 drugs and mucosal protectants 1.3 Anti-secretory drugs and mucosal protectants 1.3.3 Chelates and complexes Sucralfate 1.3.5 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 drugs and mucosal protectants 1.3.5 Proton pump inhibitors Omeprazole capsules 10mg, 20mg; dispersible tablets, film-coated, 10mg, 20mg Capsules cost much less than dispersible tablets 1.3 Anti-secretory drugs and mucosal protectants 1.3 Anti-secretory drugs and mucosal protectants 1.3 Anti-secretory drugs and mucosal protectants 1.3.5 Proton pump inhibitors Pantoprazole 1.3.5 Proton pump inhibitors Lansoprazole 1.4 Acute diarrhoea 1.4.2 Loperamide 1.4 Acute diarrhoea 1.4.2 Co-phenotrope 1.5 Chronic bowel disorders 1.5.1 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 4.7.2 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 1.5.1 Aminosalicylates Sulfasalazine (Sulphasalazine) tablets 500mg; e/c tablets 500mg; suspension 250mg in 5ml; suppositories 500mg 2 of 50

1.5 Chronic bowel disorders 1.5.1 Aminosalicylates Olsalazine 1.5 Chronic bowel disorders 1.5.1 Aminosalicylates Balsalazide 1.5 Chronic bowel disorders 1.5.2 Corticosteroids Prednisolone 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) 1.5 Chronic bowel disorders 1.5.2 Corticosteroids Hydrocortisone acetate 1.5 Chronic bowel disorders 1.5.2 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 1.6.1 Bulk-forming laxatives Ispaghula husk 1.6.2 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 1.6.2 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 1.6.2 Stimulant laxatives Docusate sodium 1.6.2 Stimulant laxatives Co-danthramer capsules 100mg; oral solution 12.5mg in 5ml, 50mg in 5ml capsules 25/200 (dantron 25 mg, poloxamer 188 200 mg), strong capsules 37.5/500 (dantron 37.5 mg, poloxamer 188 500 mg); suspension 25/200 (dantron 25 mg, poloxamer 188 200 mg) in 5ml; strong suspension 75/1000 (dantron 75 mg, poloxamer 188 1 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 1.6.2 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 1.6.4 Osmotic laxatives Lactulose 1.6.4 Osmotic laxatives Macrogol compound oral powder solution Laxido Orange oral powder sachets; Movicol-Half powder sachets; Movicol Paediatric Plain powder sachets Laxido Orange costs less than Movicol 1.6 Laxatives - see BNF for comments on the role of laxatives 1.6 Laxatives - see BNF for comments on the role of laxatives 1.6.4 Osmotic laxatives Phosphates 1.6.4 Osmotic laxatives Micralax Microenema enema BP Formula B enema 3 of 50

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 1.7 Local for anal and rectal disorders 1.6.7 Other drugs used in constipation 1.6.7 Other drugs used in constipation 1.6.7 Other drugs used in constipation 1.7.1 Soothing haemorrhoidal prepaarations 1.7.2 Compound haemorrhoidal with corticosteroids 1.7.2 Compound haemorrhoidal with corticosteroids Prucalopride Lubiprostone Linaclotide Anusol Xyloproct Scheriproct tablets 1mg, 2mg 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% Suppositories, cinchocaine (dibucaine) hydrochloride 1mg, prednisolone hexanoate 1.3mg Ointment, cinchocaine (dibucaine) hydrochloride 0.5%, prednisolone hexanoate 0.19%. For use in line with NICE's guidance. For use in line with NICE TA318 Can be purchased over the counter. First choice if corticosteroid required Second choice if corticosteroid containing suppositories required 1.7 Local for anal and rectal disorders 1.7 Local for anal and rectal disorders 1.7 Local for anal and rectal disorders 1.9 Drugs affecting intestinal secretions 1.9.1 1.7.2 Compound haemorrhoidal with corticosteroids 1.7.4 Management of anal fissures 1.7.4 Management of anal fissures Proctofoam HC Diltiazem Glyceryl trinitrate Ursodeoxycholic acid 1.9 Drugs affecting intestinal secretions 1.9.4 Creon Foam in aerosol pack, hydrocortisone acetate 1%, pramocaine hydrochloride 1%. rectal cream 2% (unlicensed)) rectal ointment 0.4% (Rectogesic ) tablets 150mg; capsules 250mg Creon 10 000 Capsules,e/c granules of pancreatin (pork), providing: protease 600 units, lipase 10 000 units, amylase 8000 units; 25 000 capsules For treatment of anal fissure. Generally not suitable for repeat prescribing For treatment of anal fissure. Generally not suitable for repeat prescribing 2.1 Positive inotropic drugs 2.1.1 Digoxin tablets 62.5mcg, 125mcg, 250mcg; elixir 50mcg in 1ml; 2.2 Diuretics 2.2 Diuretics 2.2.1 Thiazides and related diuretics 2.2.1 Thiazides and related diuretics Indapamide Chlortalidone tablets 2.5mg; MR tablets 1.5mg tablets 50mg Plain tablets cost much less than MR tablets, but both are less than 3.50 per month 2.2 Diuretics 2.2.1 Thiazides and related diuretics Bendroflumethiazide 2.2 Diuretics 2.2.2 Loop diuretics Furosemide tablets 2.5mg, 5mg tablets 20mg, 40mg, 500mg; oral solution 20mg in 5ml, 40mg in 5ml, 50mg in 5ml; 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 2.2.2 Loop diuretics Bumetanide 2.2 Diuretics 2.2.2 Loop diuretics Torasemide tablets 1mg, 5mg; Liquid 1mg in 5ml. tablets See comments column 1mg costs slightly more than furosemide 40mg For resistent oedema in patients with low egfr or poor tablet absorbtion 4 of 50

2.2 Diuretics 2.2 Diuretics 2.2 Diuretics 2.2.3 Potassium-sparing diuretics and aldosterone antagonists 2.2.3 Potassium-sparing diuretics and aldosterone antagonists 2.2.3 Potassium-sparing diuretics and aldosterone antagonists Eplerenone Spironolactone Amiloride 2.2 Diuretics 2.2.4 Potassium-sparing diur Co-amilozide 2.2 Diuretics 2.2.4 Potassium-sparing diur Co-amilofruse 2.3 Anti-arrhythmic drugs 2.3.2 Propafenone 2.3 Anti-arrhythmic drugs 2.3.2 Flecainide 2.3 Anti-arrhythmic drugs 2.3.2 Disopyramide 2.3 Anti-arrhythmic drugs 2.3.2 Amiodarone 2.4 Beta-adrenoceptor blocking drugs 2.4 Sotalol tablets 25mg, 50mg tablets 25mg, 100mg; 50 mg tablets 5mg; oral solution 5mg in 5ml tablets 2.5/25 (amiloride hydrochloride 2.5 mg, hydrochlorothiazide 25 mg), 5/50 (amiloride hydrochloride 5 mg, hydrochlorothiazide 50 mg) tablets 2.5/20 (amiloride hydrochloride 2.5 mg, furosemide 20 mg), 5/40 (amiloride hydrochloride 5 mg, furosemide 40 mg) tablets 150mg, 300mg tablets 50mg, 100mg; capsules 100mg, 150mg; tablets 100mg, 200mg; tablets 40mg, 80mg, 160mg, 200mg Costs much more than spironolactone. 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. 2.4 Beta-adrenoceptor blocking drugs 2.4 Nebivolol tablets 5mg 2.4 Beta-adrenoceptor blocking drugs 2.4 Labetalol tablets 50mg, 100mg, 200mg, 400mg; 2.4 Beta-adrenoceptor blocking drugs 2.4 Bisoprolol 2.4 Beta-adrenoceptor blocking drugs 2.4 Carvedilol 2.4 Beta-adrenoceptor blocking drugs 2.4 Propranolol tablets 1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg 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 3.75mg and 7.5mg tablets cost more than the other strengths 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. 2.4 Beta-adrenoceptor blocking drugs 2.4 Metoprolol 2.4 Beta-adrenoceptor blocking drugs 2.4 Atenolol tablets 50mg, 100mg; tablets 25mg, 50mg, 100mg; syrup 25mg in 5ml; 2.5 Hypertension and heart failure 2.5 Hypertension and heart failure 2.5 Hypertension and heart failure 2.5.1 Vasodilator antihypertensive drugs 2.5.1 Vasodilator antihypertensive drugs 2.5.2 Centrally acting antihypertensive drugs Hydralazine Minoxidil Moxonidine tablets 25mg, 50mg; tablets 2.5mg, 5mg, 10mg tablets 200mcg, 300mcg, 400mcg 5 of 50

2.5 Hypertension and heart failure 2.5 Hypertension and heart failure 2.5.2 Centrally acting antihypertensive drugs 2.5.4 Alpha-adrenoceptor blocking drugs Methyldopa Phenoxybenzamine tablets 125mg, 250mg, 500mg capsules 10mg 2.5 Hypertension and heart failure 2.5.4 Alpha-adrenoceptor blocking drugs Doxazosin 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. 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 2.5 Hypertension and heart failure 2.5.5.1 Angiotensinconverting enzyme inhibitors 2.5.5.1 Angiotensinconverting enzyme inhibitors 2.5.5.1 Angiotensinconverting enzyme inhibitors 2.5.5.1 Angiotensinconverting enzyme inhibitors 2.5.5.1 Angiotensinconverting enzyme inhibitors 2.5.5.2 Angiotensin-II receptor antagonists Ramipril Lisinopril Perindopril erbumine tablets 2mg, 4mg, 8mg Enalapril Captopril Losartan capsules or tablets 1.25mg, 2,5mg, 5mg, 10mg tablets 2.5mg, 5mg, 10mg, 20mg tablets 2.5mg, 5mg, 10mg, 20mg tablets 12.5mg, 25mg, 50mg tablets 25mg, 50mg, 100mg, 12.5 mg Ramipril capsules cost slightly less than tablets Perindopril erbumine costs more than the other ACE inhibitors listed here. Perindopril arginine (non-formulary) costs much more. 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. 2.5 Hypertension and heart failure 2.5 Hypertension and heart failure 2.5 Hypertension and heart failure 2.5.5.2 Angiotensin-II receptor antagonists 2.5.5.2 Angiotensin-II receptor antagonists 2.5.5.2 Angiotensin-II receptor antagonists Valsartan Irbesartan Candesartan 2.5 Hypertension and heart failure 2.5.5.3 Renin inhibitors Aliskiren 2.6 Nitrates, Calcium-channel blockers and other antianginal drugs 2.6 Nitrates, Calcium-channel blockers and other antianginal drugs 2.6 Nitrates, Calcium-channel blockers and other antianginal drugs 2.6.1 Nitrates Isosorbide mononitrate 2.6.1 Nitrates Glyceryl trinitrate 2.6.2 Calcium-channel blockers Verapamil capsules 40mg, 80mg, 160mg tablets 75mg, 150mg, 300mg tablets 2mg, 4mg, 8mg, 16mg, 32mg tablets 150mg, 300mg tablets 10mg, 20mg; MR capsules 25mg, 50mg; MR tablets 25mg, 40mg, 60mg aerosol spray 400mcg/metered spray; tablets 500 micrograms tablets 40mg, 80mg,120mg; MR capsules 120mg; MR tablets 240mg; oral solution 40mg in 5ml Generic unlikely before 14.8.12. Possibility that company will obtain additional 6 months protection by getting the drug licensed for use in children. Not included in NICE's clinical guideline on hypertension 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 drugs 2.6.2 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 drugs 2.6.2 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. 6 of 50

2.6 Nitrates, Calcium-channel blockers and other antianginal drugs 2.6.2 Calcium-channel blockers Amlodipine tablets 5mg, 10mg 2.6 Nitrates, Calcium-channel blockers and other antianginal drugs 2.6.3 Other antianginal drugs Nicorandil tablets 10mg, 20mg 2.6 Nitrates, Calcium-channel blockers and other antianginal drugs 2.6 Nitrates, Calcium-channel blockers and other antianginal drugs 2.6.3 Other antianginal drugs 2.6.3 Other antianginal drugs Ivabradine Ranolazine 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 drugs 2.8 Anticoagulants and protamine 2.8 Anticoagulants and protamine 2.6.4 Peripheral vasodilators and related drugs 2.8.1 Parenteral anticoagulants 2.8.1 Parenteral anticoagulants Naftidrofuryl Tinzaparin Heparin sodium or calcium capsules 100mg injection syringe 2500 units, 3500 units, 4500 units, 10,000 units, 14,000 units, 18,000 units 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 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 2.8.1 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 2.8.1 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 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Phenindione 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Phenindione tablets 10mg, 25mg, 50mg tablets 1mg 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Dabigatran etexilate capsules, 110mg, 150mg Intermittent supply problems. INR monitoring required. INR monitoring required NICE TA guidance exists 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Rivaroxaban tablets 15mg, 20mg 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Apixaban tablets 2.5mg, 5mg 2.8 Anticoagulants and protamine 2.8.2 Oral anticoagulants Warfarin 2.9 Antiplatelet drugs 2.9 Prasugrel 2.9 Antiplatelet drugs 2.9 Dipyridamole tablets 500mcg, 1mg, 3mg, 5mg tablets 5mg, 10mg tablets 25mg, 100mg; MR capsules 200mg; oral liquid 50mg in 5ml 2.9 Antiplatelet drugs 2.9 Clopidogrel tablets 75mg 2.9 Antiplatelet drugs 2.9 Aspirin 2.9 Antiplatelet drugs 2.9 Asasantin Retard tablets dispersible 75mg Capsules, aspirin 25 mg, dipyridamole 200 mg (m/r) NICE TA guidance exists NICE TA guidance exists INR monitoring required Use in line with NICE's guidance Use in line with NICE's guidance Use in line with NICE's guidance Enteric coated tablets cost more than dispersible tablets. Use in line with NICE's guidance 7 of 50

2.11 Antifibrinolytic drugs and haemostatics 2.11 Antifibrinolytic drugs and haemostatics 2.9 Antiplatelet drugs 2.9 Ticagrelor 2.11 Etamsylate 2.11 Tranexamic acid 2.12 Lipid-regulating drugs Statins Simvastatin 2.12 Lipid-regulating drugs Other Colestyramine (cholestyramine) 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 See comments column 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 2017. Generic atorvastatin will be available from May 2012. Rosuvastatin 20mg daily currently costs 338 p.a. in general practice; generic simvastatin 40mg daily costs 15. No published trials demonstrate that rosuvastatin reduces the rate of cardiovascular events when used for secondary prevention. Rosuvastatin should only be considered in the following circumstances: 1. Adults with familial hypercholesterolaemia, only if the maximum tolerated dose of atorvastatin (check the patient is taking it) fails to achieve the recommended reduction of LDL cholesterol of >50% from the baseline concentration before treatment. 2.12 Lipid-regulating drugs Statins Rosuvastatin See comments column 2. None of simvastatin ( 20mg), atorvastatin ( 10mg daily) or pravastatin 40mg is tolerated by the patient. Rosuvastatin may or may not be tolerated. Atorvastatin or rosuvastatin could be tried every other day or twice weekly (unlicensed frequency). 3. There is a potentially serious drug interaction (marked with a black dot in the BNF) with simvastatin, atorvastatin and pravastatin, but not with rosuvastatin, that cannot be avoided other than by using rosuvastatin (a clinical pharmacist should be consulted to look for a way of avoiding the interaction other than by using rosuvastatin). In BNF 61 (March 2011) the only drug with a black dot interaction listed for simvastatin, atorvastatin and pravastatin but not rosuvastatin is clarithromycin. It will often be possible to avoid this interaction by using a different antibiotic. 2.12 Lipid-regulating drugs Other Colesevelam tablets 625mg 2.12 Lipid-regulating drugs Statins Atorvastatin tablets 10mg, 20mg, 40mg, 80mg 2.12 Lipid-regulating drugs Statins Pravastatin tablets 10mg, 20mg, 40mg 2.12 Lipid-regulating drugs Other Omacor (omega-3 acid ethyl esters) capsules 1g (Omacor ). Costs more 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. 2.12 Lipid-regulating drugs Fibrates Fenofibrate capsules (micronised) 67mg, 200mg, 267mg; tablets (micronised) 160mg 8 of 50

2.12 Lipid-regulating drugs Other Ezetimibe tablets 10mg For use in line with NICE's guidance. Drug and Therapeutics Bulletin questioned whether adding ezetimibe to statin treatment is a cost-effective or outcome-based intervention. There are no published trials to show it reduces mortality or morbidity. A trial of simvastatin 20mg + ezetimibe 10mg daily in chronic kidney disease was against placebo (Lancet 2011; 377: 2181-92). 2.12 Lipid-regulating drugs Fibrates Bezafibrate 3.1 Bronchodilators 3.1 Bronchodilators 3.1.1.1 Selective beta2 agonists 3.1.1.1 Selective beta2 agonists Indacaterol Salbutamol tablets 200mg; MR tablets 400mg 150 microgram inhalation powder, hard capsules; 300 microgram inhalation powder, hard capsules Aerosol inhalation 100 micrograms/metered inhalation; Airomir Autohaler (breathactuated) 100 micrograms/metered inhalation; Ventolin Accuhaler 200micrograms/blister; Pulvinal Salbutamol 200micrograms/dose dry powder inhaler. Nebules, 2.5mg in 2.5ml, 5mg in 2.5ml 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 3.1.1.1 Selective beta2 agonists Terbutaline Turbohaler 500mcg/inhalation; Respules 5mg in 2ml Second choice short-acting beta2 agonist 3.1 Bronchodilators 3.1 Bronchodilators 3.1.1.1 Selective beta2 agonists 3.1.1.1 Selective beta2 agonists Salmeterol Formoterol aerosol inhalation 25mcg/metered inhalation; Accuhaler 50mcg/blister; Turbohaler 6mcg/inhalation, 12mcg/inhalation; inhalation capsules 12mcg 3.1 Bronchodilators 3.1 Bronchodilators 3.1 Bronchodilators 3.1 Bronchodilators 3.1.2 Antimuscarinic bronchodilators 3.1.2 Antimuscarinic bronchodilators 3.1.2 Antimuscarinic bronchodilators 3.1.2 Antimuscarinic bronchodilators Tiotropium Ipratropium bromide Glycopyrronium bromide Aclidinium bromide dry powder inhaler 18mcg capsule; Respimat solution for inhalation 2.5micrograms/metered inhalation aerosol inhalation 20mcg/metered inhalation; nebuliser solution 250mcg in 1ml, 500mcg in 2ml unit dose vials Inhalation powder 50 mcg, hard capsule, for use with Seebri Breezhaler device Dry powder inhaler 375 mcgs(= aclidinium 322 mcg)/inhalation (delivered dose) for use with Eklira Genuair device 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. For use as a second line option in the maintenance treatment of COPD. For use as a second line option in the maintenance treatment of COPD. 9 of 50

3.1 Bronchodilators 3.1.3 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 3.1.3 Theophylline Aminophylline 3.1.5 Peak flow meters, inhaler devices and nebulisers 3.1.5 Drug delivery devices 3.2 Corticosteroids 3.2 Fostair MR tablets (Phyllocontin) 225mg, 350mg; spacer devices aerosol inhalation, beclometasone dipropionate 100mcg, 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 Flutiform Turbohaler 100/6, 200/6, 400/12 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 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 Fluticasone Evohaler aerosol inhalation 50mcg/metered inhalation, 125mcg/metered inhalation, 250mcg/metered inhalation; Accuhaler 50mcg/blister, 100mcg/blister, 250mcg/blister, 500mcg/blister 10 of 50

Turbohaler 100mcg/inhalation, 200mcg/inhalation, 400mcg/inhalation; Respules 500mcg in 2ml, 1mg in 2ml 3.2 Corticosteroids 3.2 Budesonide 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. 3.2 Corticosteroids 3.2 Mometasone 3.03 Cromoglicate and related therapy and leukotriene receptor antagonists 3.3.3 Zafirlukast dry powder inhaler 200micrograms/metered inhalation, 400micrograms/metered inhalation tablets 20 mg Exceptional case for patients who cannot take beclometasone, budesonide or fluticasone. For adults zafirlukast costs less than montelukast 3.03 Cromoglicate and related therapy and leukotriene receptor antagonists 3.4 Antihistamines, hyposensitisation, and allergic emergencies 3.3.3 Montelukast 3.4.1 Cetirizine tablets 10mg; chewable tablets 4mg, 5mg granules 4mg tablets 10mg; oral solution sugar free 1mg/ml less sedating drug 3.4 Antihistamines, hyposensitisation, and allergic emergencies 3.4.1 Loratadine tablets 10mg; syrup 5mg in 5ml less sedating drug 3.4 Antihistamines, hyposensitisation, and allergic emergencies 3.4.1 Promethazine hydrochloride tablets 10mg, 25mg; elixir 5mg in 5ml 11 of 50

3.4 Antihistamines, hyposensitisation, and allergic emergencies 3.4 Antihistamines, hyposensitisation, and allergic emergencies 3.4 Antihistamines, hyposensitisation, and allergic emergencies 3.4.1 Hydroxyzine 3.4.1 Chlorphenamine 3.4.3 Adrenaline/ epinephrine tablets 10mg, 25mg syrup 10mg in 5ml tablets 4mg; syrup 2mg in 5ml; pre-filled auto-injector delivering 150 micrograms (EpiPen Junior. Jext), 300 micrograms (EpiPen, Jext), 500 micrograms (Anapen 500) Prescribe using the brand name 3.7 Mucolytics 3.7 Carbocisteine 3.7 Mucolytics 3.7 Dornase alfa 3.7 Mucolytics 3.7 3.8 Aromatic inhalations 3.8 Hypertonic sodium chloride Menthol and eucalyptus 3.9 Cough 3.9.1 Pholcodine capsules 375mg; oral liquid 250mg in 5ml nebuliser solution nebuliser solution 3%, 6%, 7% inhalation sugar-free linctus 5mg in 5ml For use in line with NICE guidance GPs should not be asked to prescribe this unless a local shared care protocol has been agreed. See BNF for limited role 3.9 Cough 3.9.1 Codeine linctus 15mg in 5ml See BNF for limited role 3.9 Cough 3.9.2 Simple linctus, linctus paediatric capsules 5mg, 10mg 4.1 Hypnotics and anxiolytics 4.1.1 Hypnotics Zaleplon See BNF for limited role 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. 4.1 Hypnotics and anxiolytics 4.1.1 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 drugs. 4.1 Hypnotics and anxiolytics 4.1.1 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 drugs. 4.1 Hypnotics and anxiolytics 4.1.1 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 drugs. 4.1 Hypnotics and anxiolytics 4.1.2 Lorazepam tablets 1mg, 2.5mg 4.1 Hypnotics and anxiolytics 4.1.2 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 4.1 Hypnotics and anxiolytics 4.1.2 Chlordiazepoxide capsules 5mg, 10mg 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.1 Hypnotics and anxiolytics 4.1.2 Buspirone tablets 5mg, 10mg 4.2.1 Antipsychotic drugs Trifluoperazine 4.2.1 Antipsychotic drugs Sulpiride tablet 1mg, 5mg; oral solution 5mg in 5ml tablets 200mg, 400mg; oral solution 200mg in 5ml. 12 of 50

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 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 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.2.1 Antipsychotic drugs Quetiapine 4.2.1 Antipsychotic drugs Olanzapine 4.2.1 Antipsychotic drugs Chlorpromazine hydrochloride 4.2.1 Antipsychotic drugs Aripiprazole 4.2.1 Antipsychotic drugs Amisulpride 4.2.1 Antipsychotic drugs Risperidone 4.2.1 Antipsychotic drugs Haloperidol 4.2.1 Antipsychotic drugs Flupentixol 4.2.1 Antipsychotic drugs Zuclopenthixol tablets 25mg, 100mg 150mg, 200mg, 300mg; MR tablets 50mg, 200mg, 300mg, 400mg 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 solution 1mg in 1ml tablets 50mg, 100mg, 200mg, 400mg; oral solution 100mg in 1ml tablets 500micrograms, 1mg, 2mg, 3mg, 4mg, 6mg, orodispersible tablets 500micrograms, 1mg, 2mg, 4mg capsules 500 micrograms; tablets 1.5mg, 5mg, 10mg, 20mg; oral liquid 10mg in 5ml; injection 5mg in 1ml tablets 3mg tablets 2mg, 10mg, 25mg 4.2.1 Antipsychotic drugs Levomepromazine tablets 25mg,injection 25mg/ml 4.2.2 Antipsychotic depot injections 4.2.2 Antipsychotic depot injections 4.2.2 Antipsychotic depot injections 4.2.2 Antipsychotic depot injections 4.2.2 Antipsychotic depot injections Aripiprazole Flupentixol decanoate Fluphenazine decanoate Haloperidol (as decanoate) Paliperidone 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 4.2.2 Antipsychotic depot injections Pipotiazine palmitate depot injection 50mg/ml 4.2.2 Antipsychotic depot injections Risperidone 4.2.2 Antipsychotic depot Zuclopenthixol injections decanoate 4.2.3 Antimanic drugs Valproic acid depot injection 25mg, 37.5mg, 50mg depot injection 200mg/ml, 500mg/ml e/c tablets 250mg, 500mg Orodispersible tablets cost more than standard tablets Orodispersible tablets cost much more than standard tablets For use in palliative care 13 of 50

4.2 Drugs used in psychoses and 4.2 Drugs used in psychoses and 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.2.3 Antimanic drugs Lithium citrate 4.2.3 Antimanic drugs Lithium carbonate 4.3.1 Tricyclic and related antidepressant drugs 4.3.1 Tricyclic and related antidepressant drugs 4.3.1 Tricyclic and related antidepressant drugs 4.3.1 Tricyclic and related antidepressant drugs 4.3.1 Tricyclic and related antidepressant drugs 4.3.1 Tricyclic and related antidepressant drugs 4.3.2 Monoamine-oxidase inhibitors 4.3.2 Monoamine-oxidase inhibitors 4.3.3 Selective serotonin reuptake inhibitors Clomipramine Trazodone Lofepramine Imipramine Amitriptyline hydrochloride Nortriptyline Moclobemide Phenelzine Sertraline liquid 520mg in 5ml (Priadel ); oral solution 509mg in 5ml (Li-liquid ); MR tablets 200mg, 400mg (Priadel, Camcolit, Liskonum ) capsules, 10mg, 25mg, 50mg capsules 50mg, 100mg; tablets 150mg; liquid 50mg in 5ml tablets 70mg; oral suspension 70mg in 5ml tablets 10mg, 25mg tablets 10mg, 25mg, 50mg; oral solution 25mg in 5ml, 50mg in 5ml tablets 10mg, 25mg tablets 150mg tablets 15mg tablets 50mg, 100mg Prescribe by brand name Prescribe by brand name 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 drugs 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.3.3 Selective serotonin reuptake inhibitors 4.3.3 Selective serotonin reuptake inhibitors 4.3.3 Selective serotonin reuptake inhibitors 4.3.4 Other antidepressant drugs Fluoxetine Citalopram Paroxetine Duloxetine capsules 20mg; liquid 20mg in 5ml dispersible tablets 20mg tablets 10mg, 20mg, 40mg; oral solution 40mg/ml sugar free tablets 20mg, 30mg 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. 4.03 Antidepressant drugs 4.03 Antidepressant drugs 4.4 Central nervous system stimulants 4.4 4.3.4 Other antidepressant drugs 4.3.4 Other antidepressant drugs Venlafaxine Mirtazapine Methylphenidate hydrochloride tablets 37.5mg, 75mg; MR tablets 75mg, 150mg, 225 mg tablets 15mg, 30mg, 45mg; Orodispersible (soluble) tablets 15mg, 30mg, 45mg 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 ) Plain tablets cost less than MR formulations. MR tablets cost much less than MR capsules. Shared care documents are in use in some parts of NWL. 14 of 50

4.4 Central nervous system stimulants 4.4 Atomoxetine Capsules, 10mg, 18mg, 25mg, 40mg, 60mg, 80mg tablets 5mg Shared care documents are in use in some parts of NWL. 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 4.4 Dexamfetamine sulphate 4.4 Central nervous system stimulants 4.4 Modafinil 4.5 Drugs used in the treatment of obesity 4.5.1 Orlistat tablets capsules 120mg NICE: Prescribe only as part of an overall plan for managing obesity in adults who have: a BMI of 28.0 kg/m2 or more with associated risk factors, or a BMI of 30.0 kg/m2 or more. Continue treatment for longer than 3 months only if the person has lost at least 5% of their initial body weight since starting drug treatment (less strict goals may be appropriate for people with type 2 diabetes). Continue for longer than 12 months (usually for weight maintenance) only after discussing potential benefits and limitations with the patient. Co-prescribing with other drugs for weight reduction is not recommended. 4.6 Drugs used in nausea and vertigo 4.6 Prochlorperazine 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 4.6 Drugs used in nausea and vertigo 4.6 4.6 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 4.7.1 Non-opioid analgesics and compound analgesic Paracetamol tablets 5mg, buccal tablets 3mg; syrup 5mg in 5ml 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 tablets 300micrograms tablets 8mg 16mg tablets 4mg, 8mg; oral solution4mg/5ml; injection 2mg/ml tablets 500mg; dispersible tablets 500mg; oral suspension sugar free 120mg in 5ml, 250mg in 5ml For hypersalivation associated with clozapine therapy [unlicensed indication] Suppositories cost much more than tablets and liquids 4.7 Analgesics 4.7.1 Non-opioid analgesics and compound analgesic Co-dydramol tablets 10/500 15 of 50

4.7 Analgesics 4.7.1 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 4.7.1 Non-opioid analgesics and compound analgesic Aspirin dispersible tablets 300mg tablets 30mg 4.7 Analgesics 4.7.1 Non-opioid analgesics and compound analgesic Nefopam 4.7 Analgesics 4.7.2 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 of 50

4.7 Analgesics 4.7.2 Opioid analgesics Morphine sulphate 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, 30mg/sachet, 60mg/sachet, 100mg/sachet, 200mg/sachet; suppositories 10mg,15mg, 30mg; injections 10mg/ml, 15mg/ml, 20mg/ml, 30mg/ml oral strong opioid. Reserve MR suspension sachets for people who cannot take MR tablets 4.7 Analgesics 4.7.2 Opioid analgesics Diamorphine 4.7 Analgesics 4.7.2 Opioid analgesics Methadone 4.7 Analgesics 4.7.2 Opioid analgesics Oxycodone 4.7 Analgesics 4.7.2 Opioid analgesics Tapentadol 4.7 Analgesics 4.7.2 Opioid analgesics Tramadol hydrochloride injection 5mg, 10mg, 30mg, 100mg, 500mg tablets 5mg; injection 10mg/ml capsules 5mg, 10mg, 20mg; MR tablets 5mg, 10mg, 20mg, 40mg, 80mg; oral solution 5mg in 5ml, 50mg 50mg, 75mg; MR tablets 50mg, 100mg, 150mg, 200mg, 250mg Capsule 50mg MR tablets 100mg, 150mg, 200mg. MR capsules, 50mg, 100mg, 150mg, 200mg 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. Marol appears to be the cheapest brand of modified release 12 hourly tramadol listed in the BNF. 4.7 Analgesics 4.7.2 Opioid analgesics Dihydrocodeine tablets 30 mg 4.7 Analgesics 4.7.2 Opioid analgesics Codeine phosphate Tablets codeine phosphate 15 mg, 30 mg, 60 mg 4.7 Analgesics 4.7.2 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 17 of 50

4.7 Analgesics 4.7.4 Antimigraine drugs Sumatriptan tablets 50mg, 100mg; injection pre-filled syringe and refill pack 6mg in 0.5ml; nasal spray 10mg in 0.1ml, 20mg in 0.1ml 4.7.4.1 Treatment of acute migraine 4.7 Analgesics 4.7.4 Antimigraine drugs Zolmitriptan 4.7 Analgesics 4.7.4 Antimigraine drugs Pizotifen 4.7 Analgesics 4.7.4 Antimigraine drugs Naratriptan orodispersible tablets 2.5mg, 5mg tablets 500 micrograms, 1.5 mg tablets 2.5mg 4.7.4.1 Treatment of acute migraine 4.7.4.2 Prophylaxis of migraine. Of limited value and may cause weight gain (BNF). Beta-blockers, tricyclic antidepressants and some other drugs are also used for preventing migraine. 4.7.4.1 Treatment of acute migraine tablets 12.5mg 4.7.4.1 Treatment of acute migraine 4.7 Analgesics 4.7.4 Antimigraine drugs Almotriptan 4.8 Antiepileptics 4.8.1 Vigabatrin tablets 500mg; powder 500mg/sachet 4.8 Antiepileptics 4.8.1 Topiramate 4.8 Antiepileptics 4.8.1 Tiagabine 4.8 Antiepileptics 4.8.1 Sodium valproate 4.8 Antiepileptics 4.8.1 Primidone 4.8 Antiepileptics 4.8.1 Pregabalin 4.8 Antiepileptics 4.8.1 Phenytoin tablets 25mg, 50mg, 100mg, 200mg; sprinkle capsules 15mg, 25mg, 50mg tablets 5mg, 10mg, 15mg ec tablets 200mg, 500mg; MR tablets 200mg, 300mg, 500mg; crushable tablets 100mg; liquid (sugar-free) 200mg in 5ml; solution tablet 250 mg capsules 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg capsules phenytoin sodium 25mg, 50mg, 100mg, 300mg; tablets phenytoin sodium 100mg; chewable tablets phenytoin 50mg; suspension phenytoin 30mg in 5ml For use in line with NICE's guidance 4.8 Antiepileptics 4.8.1 Phenobarbital 4.8 Antiepileptics 4.8.1 Oxcarbazepine tablets 15mg, 30mg, 60mg; elixir 15mg/5ml tablets 150mg, 300mg, 600mg; oral suspension 300mg in 5ml. 4.8 Antiepileptics 4.8.1 Levetiracetam tablets 250mg, 500mg, 750mg, 1g; oral liquid 500mg in 5ml; 18 of 50

4.8 Antiepileptics 4.8.1 Lamotrigine 4.8 Antiepileptics 4.8.1 Perampanel 4.8 Antiepileptics 4.8.1 Gabapentin tablets 25mg, 50mg, 100mg, 200mg; dispersible tablets 5mg, 25mg, tablets 2mg, 4mg,6mg, 8mg, 10mg, 12mg capsules 100mg, 300mg, 400mg. Tablets 600mg 4.8 Antiepileptics 4.8.1 Ethosuximide 4.8 Antiepileptics 4.8.1 Clonazepam 4.8 Antiepileptics 4.8.1 Clobazam 4.8 Antiepileptics 4.8.1 Carbamazepine capsules 250 mg tablet 500micrograms tablets 10mg; tablets 100mg, 200mg, 400mg; MR tablets 200mg, 400mg; tablets chewable 100mg, 200mg; liquid 100mg in 5ml 4.8 Antiepileptics 4.8.1 Retigabine 4.8 Antiepileptics 4.8.1 Lacosamide tablets 50mg, 100mg, 200mg, 300mg, 400mg; starter pack tablets 50mg, 100mg, 150mg, 200mg; Syrup, 50mg in 5ml. 4.8 Antiepileptics 4.8.1 Zonisamide 4.9 Drugs used in parkinsonism and 4.9.1 Selegiline capsules 25mg, 50mg, 100mg tablets 1.25mg, 5mg, 10mg; oral liquid 10mg in 5ml 4.9 Drugs used in parkinsonism and 4.9.1 Rotigotine patches 2mg/24hr, 4mg/24hr, 6mg/24hr, 8mg/24hr 4.9 Drugs used in parkinsonism and 4.9.1 Ropinirole tablets 250microgram, 500micrograms, 1mg, 2mg, 5mg; MR tablets 2mg, 4mg, 8mg; starter pack; follow-on pack tablet 1 mg 4.9 Drugs used in parkinsonism and 4.9.1 Rasagiline mesilate 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and 4.9.1 Pramipexole 4.9.1 Entacapone tablets 88microgram, 180micrograms, 350micrograms, 700micrograms; MR tablets 260micrograms, 520micrograms, 1.05mg, 1.57mg, 2.1mg, 2.62mg, 3.15mg tablets 200mg 19 of 50

4.9 Drugs used in parkinsonism and 4.9.1 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 4.9.1 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 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and 4.9 Drugs used in parkinsonism and 4.9.1 Stalevo 4.9.1 Amantadine 4.9.2 Trihexyphenidyl 4.9.2 Procyclidine 4.9.2 4.9.3 Drugs used in essential tremor, chorea, tics, and Orphenadrine hydrochloride Riluzole tablets capsules 100mg tablets 2mg, 5mg; syrup 5mg in 5ml tablets 5mg; sugar free syrup 2.5mg in 5ml, 5mg in 5ml tablet 50 mg tablets 50mg 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. 4.9 Drugs used in parkinsonism and 4.9.3 Drugs used in essential tremor, chorea, tics, and Tetrabenazine tablets 25mg 4.10 Drugs used in substance dependence 4.10.1 Alcohol dependence Acamprosate Calcium tablet 333 mg 20 of 50