EDICIES FORULARY JAUARY 2017 This version supersedes all previous versions for edicines Formulary
olicy title edicines Formulary olicy HA05 reference olicy category harmacy Relevant to All staff handling medicines Date published January 2017 Implementation January 2017 date Date last January 2017 reviewed ext review Following DTC formulary decisions as and when applicable date olicy lead Chief harmacist Contact details Accountable director Approved by (Group/Comm): Ratified by (Committee): Document history Email: Telephone: lucy.reeves@candi.nhs.uk Dr Vincent Kirchner, edical Director Drug and Therapeutics Committee December 2016 Date Version Summary of amendments Jan 2017 13 ew inclusion / amendment Dec 2016 12 ew inclusion Dec 2015 11 ew inclusion Sep 2015 10 Removal Apr 2015 9 Review of approvals Feb 2015 8 ew inclusions / removal Sep 2014 7 ew inclusions ar 2014 6 ew inclusions ov 2013 5 ew inclusions July 2013 4 ew inclusions Apr 2013 3 ICE compliance Feb 2013 2 ICE compliance ov 2012 1 Full review, ICE compliance, scope of practice embership of the policy development/ review team Lucy Reeves, Chief harmacist Lead harmacists TRUST EDICIES FORULARY_HA05_January 2017_V13
Consultation Drug and Therapeutics Committee DO OT AED THIS DOCUET Further copies of this document can be found on the Foundation Trust intranet. TRUST EDICIES FORULARY_HA05_January 2017_V13
Camden & Islington HS Foundation Trust edicines Formulary edicines Formulary olicy The formulary is a list of medicines approved for use (BF limits) within the Trust. The process for introducing medicines onto the Trust formulary is documented in the Trust edicines Formulary olicy. The C&I FT formulary applies only to psychiatric medicines. All physical medicines should adhere to local acute trust and primary care policies and procedures. For medicines not included in this list refer to the edicines Formulary olicy (Section 7: Use of non-formulary medicines). Refer to the Trust edicines anagement olicy (Appendix 5: olicy for the off-label use of medicines and unlicensed medicines) for further information on unlicensed medicines (UL) and off-label uses and the approval process. Independent on edical rescribers: Scope of practice edicines that have been approved for prescribing by Independent on edical rescribers, authorised to practice within the Trust, are annotated. Independent prescribing must be within the limits of the Trust on edical rescribing olicy, which is for patients with an existing diagnosis who have been seen by the Consultant within the last year and must be within their scope of practice. Independent on edical rescribers working in Addiction Services may only prescribe medicines listed within the Drugs used in substance dependence section of the formulary. Independent on edical rescribers may only prescribe medicines listed for nicotine dependence within the Drugs used in substance dependence section. rescribing and Treatment Guidelines This is not a guideline and does not make recommendations about treatment. Reference should be made to the Trust treatment guidelines on Trustnet or the current edition of audsley & Oxleas rescribing Guidelines. lease consult the current BF for prescribing information and/or the Summary of roduct Characteristics (SC) for the respective medicine, available at http://www.medicines.org.uk/ The formulary list below generally follows the BF categorisation system. Approved unlicensed medicines and off-label use of medicines are annotated where appropriate. TRUST EDICIES FORULARY_HA05_January 2017_V13
British ational Formulary: Chapter 4 4.0 CETRAL ERVOUS SYSTE 4.1 Hypnotics and Anxiolytics 4.1.1 Hypnotics Benzodiazepines Temazepam CD Tablet 10mg, 20mg Oral solution 10mg/5ml Approved (2 nd line option): insomnia (short term use) Trust guidance/policy: Guidelines for the anagement of Insomnia; Controlled Drug policy ICE(TA77) Z drugs Zopiclone Tablet 3.75mg, 7.5mg Approved (1 st line option): insomnia (short term use) Zolpidem tartrate Tablet 5mg, 10mg Approved (3 rd line option): insomnia (short term use) Antihistamine romethazine Tablets, elixir Approved pregnant women elatonin receptor agonist elatonin R tablets (licensed) Tablets, oral solution (unlicensed) Approved restricted use: Sleep disorders in patients with learning disabilities (off label indication) Trust guidance/policy: Guidelines for the anagement of Insomnia; ICE(TA77) Trust guidance/policy: Guidelines for the anagement of Insomnia; ICE(TA77) ICE CG 192 ICE G11 (CL JFC approved) 4.1.2 Anxiolytics Benzodiazepines BF section 4.8.1 Chlordiazepoxide Capsules 5mg, 10mg Approved: anxiety (short term use); alcohol withdrawal (section 4.10) Clonazepam Tablet 500microgram, 2mg Liquid 500microgram/5ml, 2mg/5ml Approved: off-label use anxiety (short term) TRUST EDICIES FORULARY_HA05_January 2017_V13
Diazepam Lorazepam Tablet 2mg, 5mg,10mg Oral solution 2mg/5ml, 5mg/5ml Tablet 1mg Injection 4mg/ml Approved (1 st line option): anxiety (short term use); alcohol withdrawal (section 4.10) Approved (1 st line option): anxiety (short term use); off-label use for treatment of acute phase of mania and aggression / rapid tranquilisation Trust guidance: Rapid Tranquilisation guidelines ICE(CG25) Buspirone Buspirone hydrochloride Tablet 5mg, 10mg Approved: anxiety (short term use) Beta-blockers BF section 2.4 ropranolol Tablet 10mg, 40mg Approved: Autonomic symptoms of anxiety Antidepressants AOI Citalopram* Fluoxetine* aroxetine Sertraline* Venlafaxine (Escitalopram) henelzene* oclobemide See section 4.3 See section 4.3 Approved (1 st /2 nd line option): (off-label*) use in generalised anxiety disorder (GAD) and panic disorder; (1 st / 2 nd line option) social anxiety disorder (B. Escitalopram may only be prescribed for social anxiety disorder and only if other SSRIs not appropriate) Approved (3 rd line option): (off-label*) use in social anxiety disorder ICE(CG113) ICE(CG159) ICE(CG159) Antiepileptic BF section 4.8.1 regabalin See section 4.3 Approved (3 rd line option): treatment of GAD, where either two SSRIs or one SSRI and an SRI have been tried and failed or not tolerated Higher cost preparation rescribe as twice daily dosing regime. Caution: risk of misuse in SS/prison services ICE(CG113) Antihistamine BF section 4.1.1 romethazine Injection 25mg/ml Tablets, liquid Approved (2 nd line option): off-label use for treatment of acute phase of mania and aggression / rapid tranquilisation Trust guidance: Rapid Tranquilisation guidelines 4.2 Drugs used in psychosis and related disorders TRUST EDICIES FORULARY_HA05_January 2017_V13
4.2.1 Antipsychotic drugs Typical antipsychotics Benperidol Tablets 250microgram Approved - Restricted use: Control of deviant antisocial sexual behaviour Chlorpromazine Flupentixol Haloperidol Sulpiride Trifluoperazine hydrochloride Tablet 25mg, 50mg, 100mg Oral solution 25mg/5ml, 100mg/5ml Tablet 3mg See section 4.2.2 for depot preparation Tablet 500microgram, 1.5mg, 5mg, 10mg Capsule 500 microgram Oral liquid 1mg/ml, 2mg/ml Injection 5mg/ml See section 4.2.2 for depot preparation Tablet 200mg. 400mg Oral solution 200mg/5ml Tablet 1mg, 5mg Oral solution 5mg/5ml Approved: schizophrenia and related psychoses; mania; short term adjunctive management of psychomotor agitation, excitement and violent or dangerously impulsive behaviour; Approved: schizophrenia and other psychoses; depression (BF section 4.3.4) Approved: schizophrenia and other psychoses; mania; short term adjunctive management of psychomotor agitation, excitement and violent or dangerously impulsive behaviour; short term adjunctive management of severe anxiety. Approved: schizophrenia Approved: schizophrenia and other psychoses; short term adjunctive management of psychomotor agitation, excitement and violent or dangerously impulsive behaviour Approved: schizophrenia and other psychoses Trust guidance: Antipsychotic rescribing guidelines; Rapid Tranquilisation guidelines Should never be given parenterally due to risk of severe hypotension and prolonged unconsciousness, plus reported association of high doses with sudden death. Also extremely painful parenterally. ICE(CG82) Trust guidance: Antipsychotic rescribing guidelines ICE(CG82) Trust guidance: Antipsychotic rescribing guidelines; Rapid Tranquilisation guidelines ICE(CG82); (CG25) Trust guidance: Antipsychotic rescribing guidelines ICE(CG82) Trust guidance: Antipsychotic rescribing guidelines ICE(CG82) Zuclopenthixol Tablet 2mg, 10mg, 25mg Trust guidance: Antipsychotic dihydrochloride rescribing guidelines ICE(CG82) Zuclopenthixol Injection 50mg/ml, Approved: short term management of acute Trust guidance: Antipsychotic TRUST EDICIES FORULARY_HA05_January 2017_V13
acetate (Clopixol Acuphase ) 100mg/2ml See section 4.2.2 for depot preparation zuclopenthixol deconoate psychoses, mania or exacerbations of chronic psychoses rescribing guidelines; Clopixol Acuphase guideline; Rapid Tranquilisation guidelines ICE(CG25) Atypical antipsychotics Amisulpride Aripiprazole Clozapine Tablet 50mg, 100mg, 200mg, 400mg Solution 100mg/ml Tablets 5mg, 10mg,15mg Orodispersible tablets 10mg, 15mg Injection 7.5mg/ml (9.75mg vial) Tablet 25mg, 100mg (Clozaril ) Approved: schizophrenia; off-label use in psychoses Off-label use for short term treatment of persistent aggression in moderate to severe Alzheimer s dementia where risk of harm to self & others; Approved: schizophrenia; treatment & recurrence prevention of mania Off-label use for short term treatment of persistent aggression in moderate to severe Alzheimer s dementia where risk of harm to self & others. Adjunctive treatment in depression Approved: control of agitation & disturbed behaviour in schizophrenia Approved: schizophrenia (unresponsive to, or intolerant of conventional antipsychotics) Trust guidance: Antipsychotic rescribing guidelines Short term use only in Alzheimer s Disease & to be reviewed regularly ICE(CG82) Trust guidance: Antipsychotic rescribing guidelines. Short term use only in Alzheimer s Disease & to be reviewed regularly higher cost ICE(CG82); (CG90) Trust guidance:; Rapid Tranquilisation guidelines Antipsychotic rescribing guidelines Trust guidance/policy: Antipsychotic rescribing guidelines; Initiating clozapine in the community policy; Clozapine red result policy; Clozapine therapeutic drug monitoring; Clozaril tablets: atient, prescriber and supplying pharmacy must be registered with the Clozaril atient onitoring Service (CS) Liquid suspension 50mg/ml (Denzapine ) amed patient only via on formularly request form: Denzapine suspension only ICE(CG82) Denzapine suspension: atient, prescriber and pharmacy TRUST EDICIES FORULARY_HA05_January 2017_V13
licensed preparation available. must be registered with Denzapine atient onitoring Service (DS). Olanzapine Quetiapine Tablet 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg Orodispersible tablet 5mg, 10mg, 15mg,20mg Injection (Zyprexa ) 10mg/2ml vial Tablet 25mg, 100mg, 150mg, 200mg, 300mg odified release tablet 50mg, 200mg, 300mg,400mg Approved: schizophrenia; treatment & recurrence prevention of mania; control of agitation & disturbed behaviour in schizophrenia or mania; off-label use in psychoses Off-label use for short term treatment of persistent aggression in moderate to severe Alzheimer s dementia where risk of harm to self & others. Adjunctive treatment in depression ot Approved Approved: schizophrenia; treatment and prevention of mania and depression in bipolar disorder; Off-label use for short term treatment of persistent aggression in moderate to severe Alzheimer s dementia where risk of harm to self & others. Adjuntive treatment in depression (IR formulation approved for off-label use) Trust guidance: Antipsychotic rescribing guidelines Short term use only in Alzheimer s Disease & to be reviewed regularly ICE(CG82); (CG25); (CG90) Trust guidance: Antipsychotic rescribing guidelines Instant release tablets should be prescribed. /R tablets: Higher cost - only use where specifically required (prescribe as R tablets ) ICE(CG82); (CG90) Risperidone Tablet 500microgram, 1mg, 2mg, 3mg, 4mg, 6mg Orodispersible tablet 500microgram, 1mg, 2mg, 3mg, 4mg Liquid 1mg/ml See section 4.2.2 for depot preparation Approved 1 st line option: acute & chronic psychoses; mania; short term treatment of persistent aggression in moderate to severe Alzheimer s dementia where risk of harm to self & others; short term treatment of persistent aggression in conduct disorder. Adjuctive treatment in depression. Trust guidance: Antipsychotic rescribing guidelines Short term use only in Alzheimer s Disease & to be reviewed regularly: Only licensed for short term (6 weeks) treatment of persistent aggression in Alzheimer s dementia / conduct disorder. ICE(CG82); (CG25); (CG90) TRUST EDICIES FORULARY_HA05_January 2017_V13
4.2.2 Antipsychotic depot injections Depot antipsychotics typicals Flupentixol decanoate Fluphenazine decanoate Haloperidol decanoate Zuclopenthixol decanoate Injection 20mg/ml (1ml, 2ml amp) Injection (Depixol conc ) 100mg/ml (0.5ml, 1ml amp) Injection (Depixol Low Volume ) 200mg/ml Injection 25mg/ml (0.5ml, 1ml amp) Injection (odecate conc ) 100mg/ml (0.5ml,1ml amp) Injection 50mg/ml, 100mg/ml Injection 200mg/ml Injection (Clopixol conc ) 500mg/ml Approved (1 st line option): maintenance in schizophrenia and other psychoses Approved (1 st line option): maintenance in schizophrenia and other psychoses Approved (1 st line option): maintenance in schizophrenia and other psychoses Approved (1 st line option): maintenance in schizophrenia and other psychoses Trust guidance: Depot antipsychotic medication guidelines; Antipsychotic rescribing guidelines ICE(CG82) Trust guidance: Depot antipsychotic medication guidelines; Antipsychotic rescribing guidelines ICE(CG82) Trust guidance: Depot antipsychotic medication guidelines; Antipsychotic rescribing guidelines ICE(CG82) Trust guidance: Depot antipsychotic medication guidelines; Antipsychotic rescribing guidelines ICE(CG82) Depot antipsychotics - atypicals Aripiprazole long acting injection Risperidone long acting injection aliperidone long acting injection (monthly) Injection 400mg Injection 25mg, 37.5mg, 50mg Injection 50 mg, 75 mg, 100 mg, 150 mg Approved: maintenance treatment of schizophrenia and other psychoses in patients stabilised with oral aripiprazole Approved: maintenance in schizophrenia and other psychoses in patients tolerant to risperidone orally Approved- Restricted Use; treatment of adults with schizophrenia and in patients that have a documented response and tolerability to risperidone. Trust guidance: Depot antipsychotic medication guidelines; Antipsychotic rescribing guidelines ICE(CG82) Trust guidance: Depot antipsychotic medication guidelines; Antipsychotic rescribing guidelines ICE(CG82) aliperidone oral tablets are OT approved for use in C&I. Typical antipsychotic depots should be considered prior to TRUST EDICIES FORULARY_HA05_January 2017_V13
aliperidone prolonged release suspension for injection (three monthly) Injection 175 mg, 263 mg, 350 mg, 525 mg ay only be initiated by a consultant, on completion of non-formulary form. Approved- Restricted Use; for the maintenance treatment of schizophrenia in adult patients who are clinically stable on 1- monthly paliperidone palmitate injectable product ay only be initiated by a consultant, on completion of an non-formulary form. initiating paliperidone palmitate due to the significant financial implications. aliperidone is the active metabolite of risperidone. It has not demonstrated greater efficacy over other antipsychotics. ICE(CG82) Reserved for patients unable to comply with monthly injections and susceptible to relapse. Olanzapine Embonate ot Approved 4.2.3 Antimanic Drugs Benzodiazepines See section 4.1.2 Approved: Off label use for treatment of BF section 4.1.2 acute phase of mania. Diazepam Chlordiazepoxide Lorazepam Clonazepam idazolam Should not be used for long periods because of risk of dependence. ICE(CG185) Antipsychotics BF section 4.2.1 Haloperidol Olanzapine Quetiapine Risperidone Aripiprazole See section 4.2.1 Approved: treatment of mania; Olanzapine & aripiprazole are also licensed for prevention in patients whose manic episode responded to the respective drug Aripiprazole higher cost ICE(CG185) Lithium Lithium carbonate Tablet (riadel ) 200mg, 400mg Approved: treatment and prophylaxis of mania, bipolar disorder and recurrent ust be prescribed by brand. reparations vary widely in TRUST EDICIES FORULARY_HA05_January 2017_V13
Lithium citrate Liquid (riadel) 520mg/5ml (5ml = 204mg lithium carbonate) Liquid (Li-liquid) 509mg/5ml (5ml = 200mg lithium carbonate) depression bioavailablity: changing preparations requires the same precautions as initiation of treatment. ote: lithium carbonate 200mg = lithium citrate 509mg ICE(CG185) Lamotrigine Sodium valproate Semisodium valproate (Depakote ) Tablet 25mg, 50mg, 100mg, 200mg Dispersible tablet 5mg, 25mg, 100mg Tablet crushable 100mg Tablet e/c 200mg, 500mg Tablet R 200mg, 300mg, 500mg Liquid 200mg/5ml Approved: Off-label treatment and prophylaxis of depressive episode in BAD Approved: Off-label use in bipolar affective disorder (BAD). ICE(CG185) ICE(CG185) Tablet e/c 250mg, 500mg ot Approved Higher cost preparation 4.3 Antidepressant Drugs 4.3.1 Tricyclic and related antidepressant drugs Tricyclic antidepressants Amitriptyline hydrochloride Clomipramine hydrochloride Imipramine hydrochloride Tablet 10mg, 25mg, 50mg Liquid 25mg/ml Capsules 10mg, 25mg, 50mg Tablet 10mg, 25mg Approved: Depression Approved: Depression, phobic & obsessional states, off-label use panic disorder Approved: Depression; off label use panic disorder Lofepramine Tablet 70mg Approved: Depression TRUST EDICIES FORULARY_HA05_January 2017_V13 Amitriptyline particularly dangerous in overdose 1 ICE(CG90);(CG91);(CG38) ICE(CG90);(CG91);(CG38); (CG113) ICE(CG90);(CG91);(CG38); (CG113)
Liquid 70mg/5ml ICE(CG90);(CG91);(CG38) Related antidepressants ianserin hydrochloride Tablet 10mg, 20mg, 30mg Approved: Depression Trazadone Tablets, Liquid Approved: Depression See BF advice regarding blood monitoring before prescribing ICE(CG90);(CG91);(CG38) 4.3.2 onoamine-oxidase Inhibitors (AOIs) AOIs henelzine Tablet 15mg Approved: Depression, social anxiety disorder (off label) Less suitable for prescribing due to dangers of dietary & drug interactions ICE(CG90);(CG91);(CG38) (CG 159) Reversible AOIs oclobemide Tablet 150mg, 300mg Approved: Depression, social anxiety disorder ICE(CG90);(CG91);(CG38) (CG159) 4.3.3 Selective Serotonin Re-uptake Inhibitors (SSRIs) SSRIs Citalopram Tablet 10mg, 20mg, 40mg Fluoxetine Liquid (Cipramil oral drops) 40mg/ml Capsule 20mg Liquid 20mg/5ml Approved (1 st line option*): Depression; panic disorder; off-label use in generalised anxiety disorder (GAD) Approved (1 st line option): Depression; bulimia nervosa; obsessive-compulsive *Associated with dose related QT prolongation, therefore avoid in specific patient groups see BF. 4 drops (8mg) Cipramil oral drops is equivalent in therapeutic effect to 10mg citalopram tablet. ICE(CG90/91);(CG91);(CG38); (CG113) ICE(CG90/91);(CG91);(CG38); TRUST EDICIES FORULARY_HA05_January 2017_V13
disorder (OCD); off-label use in GAD aroxetine Tablet 10mg, 20mg, 30mg Approved: Depression; OCD; panic Liquid 10mg/5ml disorder; social anxiety disorder; TSD, offlabel use in GAD Sertraline Tablet 50mg, 100mg Approved (1 st line option): Depression; OCD; panic disorder; social anxiety disorder; TSD, off-label use in GAD (CG113) ICE(CG90);(CG91);(CG38); (CG113) (CG159) ICE(CG90);(CG91);(CG38); (CG113) (CG159) 4.3.4 Other antidepressant drugs Antipsychotic Flupentixol Tablet 500microgram, 1mg 3mg Approved: depression; psychoses (see BF section 4.2.1) ICE(CG90)(CG91) resynaptic alpha 2- adrenoceptor blocker Selective noradrenaline re-uptake inhibitor irtazapine Tablet 15mg, 30mg, 45 mg Approved: major depression Reboxetine Tablet 4mg Approved: major depression ICE(CG90);(CG91);(CG38) ICE(CG90);(CG91);(CG38);(CG1 13) Tryptophan Tryptophan (L-Tryptophan) Tablet 500mg Approved- Restricted use: amed patient only for major depression ICE(CG90);(CG91);(CG38) Serotonin & noradrenaline re-uptake inhibitor (SRI) Venlafaxine Tablet 37.5mg, 75mg Tablet R 37.5mg, 75mg, 150mg, 225mg (Capsules R 75mg, 150mg) Approved: major depression; generalised anxiety disorder, social anxiety disorder Immediate release tablets should be prescribed 1 st line. /R tablets: Higher cost only use where specifically required (R capsules should not be prescribed ) ICE(CG90);(CG91);(CG38); (CG113) (CG159) TRUST EDICIES FORULARY_HA05_January 2017_V13
noradrenaline & dopamine reuptake inhibitor Duloxetine ot approved Bupropion R tablet 150mg, 300mg Approved: major depression (off-label) Consultant initiation only where ICE recommended treatments for mono or adjunctive therapy are ineffective or not tolerated. See Trust Antidepressant prescribing guidelines. elatonin agonist, serotonin antagonist Direct modulation of receptor activity & inhibition of serotonin transported Agomelatine ot approved (excluded from ICE guidance) Vortioxetine Tablet 5, 10, 20mg Approved: (3 rd line option) major depression (where inadequate response to 2 antidepressants within current episode) ICE(TA231) Terminated ICE TA367 4.4 CS stimulants and other drugs used for Attention Deficit Hyperactivity Disorder (ADHD) CS Stimulants ethylphenidate hydrochloride CD Dexamphetamine CD Lisdexamfetamine CD Tablet (immediate release) 5mg, 10mg Concerta XL tablets [22/78] 18mg, 27mg, 36mg Equasym XL capsules [30/70] 10mg, 20mg, 30mg edikinet XL capsules [50/50] 5mg, 10mg, 20mg, 30mg, 40mg 5mg tablets Capsulea 30mg, 50mg, 70mg Approved: Off-label use in adult (>18years) Attention deficit hyperactivity disorder (ADHD) Approved: (3 rd line option) Off-label use in adult (>18years) Attention deficit hyperactivity disorder (ADHD) Approved: (3 rd line option) Off-label use in adult (>18years) Attention deficit hyperactivity disorder (ADHD) XL preparations should be prescribed by specific brand name ICE(CG72); [ICE(TA98)] ICE(CG72); [ICE(TA98)] TRUST EDICIES FORULARY_HA05_January 2017_V13
on-cs Stimullants Atomoxetine Capsules 10mg, 18mg, 25mg, 40mg, 60mg Approved: Off-label use in adult (>18years) Attention deficit hyperactivity disorder (ADHD) ICE(CG72); [ICE(TA98)] 4.5 Drugs used in nausea & vertigo Hyoscine Hyoscine hydrobromide Chewable tablet (Kwells ) 300microgram Approved: Off-label treatment of clozapine induced hypersalivation 1.6 Laxatives Osmotic Lactulose Solution 3.1-3.7g/5ml Approved: treatment of clozapine induced laxatives constipation 4.9.2 Antimuscarinic drugs used in parkinsonism Antimuscarinic drugs Orphenadrine rocyclidine Trihexyphenidyl (benzhexol hydrochloride) Tablet 50mg Liquid 50mg/ml Tablet 5mg Liquid 2.5mg/5ml Injection 5mg/ml Tablet 2mg, 5mg Liquid 5mg/ml Approved: parkinsonism; drug induced extrapyramidal symptoms Approved: parkinsonism; drug induced extrapyramidal symptoms Approved: parkinsonism; drug induced extrapyramidal symptoms, clozapine induced hypersalivation (off-label) ot tardive dyskinesia ot tardive dyskinesia ot tardive dyskinesia 4.10 Drugs used in substance dependence TRUST EDICIES FORULARY_HA05_January 2017_V13
Alcohol dependence Vitamin B group BF section 9.6.2 Acamprosate Tablet 333mg Approved: maintenance of abstinence in alcohol dependence Chlordiazepoxide Capsule 5mg, 10mg Approved: alcohol detoxification Diazepam BF section4.1.2 Tablet 2mg, 5mg, 10mg Liquid 2mg/5ml, 5mg/5ml Approved: off-label use in alcohol detoxification; Oxazepam Tablet 10mg Approved: off-label use in alcohol detoxification; Disulfiram Tablet 200mg Approved: maintenance of abstinence in alcohol dependence altrexone Tablet 50mg Approved: aintenance of abstinence in alcohol dependence almefene Tablets Approved: Reduction of alcohol consumption Thiamine Tablets 50mg Approved: Treatment & prophylaxis of Wernicke/Korsakoff Vitamin B compound strong Tablets Approved: prophylactic supplement during detoxification abrinex I/ high potency injection Approved: Treatment & prophylaxis of Wernicke/Korsakoff SS only initiation ICE(CG115) ICE(CG115) ICE(CG115) For use when liver function significantly impaired SS only initiation ICE(CG115) SS only initiation ICE(CG115) SS initiation only ICE TA 325 ICE(CG100) ICE(CG100) Caution: anaphylaxis may occur following injection, facilities to treat must be available when administered. ICE(CG100) Benzodiazepine dependence Diazepam BF section4.1.2 Tablet 2mg, 5mg, 10mg Liquid 2mg/5ml, 5mg/5ml Approved: off-label use in benzodiazepine dependence icotine dependence icotine replacement therapy (RT) atches RT Lozenges atches 7mg, 14mg, 15mg, 21mg; 25mg Lozenge 1mg, 2mg, 4mg Approved: treatment for smoking cessation Restricted to inpatient and Community Smoking Cessation Team prescribing only for the treatment of smoking cessation. TRUST EDICIES FORULARY_HA05_January 2017_V13
RT Gum RT Inhaler RT asal Spray RT Oral spray Gum 1mg, 2mg, 4mg Inhaler 10mg, 15mg asal spray 500mcg Oral spray 1mg/metered dose ICE(H10) Varenicline Tablets 0.5mg, 1mg Approved: treatment for smoking cessation Trust guidance: ot recommended for acute inpatients ICE(H10);(TA123) Opioid Dependence Buprenorphine (Subutex ) CD Tablet sublingual 400microgram, 2mg, 8mg Approved: substitution treatment in opioid dependence Lofexidine Tablet 200 microgram Approved: management of symptoms in opioid detoxification ethadone CD orphine Sulphate odified Release CD BF section4.7.2 Oral solution sugar free, 1mg/ml Oral solution 1mg/ml Concentrated oral solution 10mg/ml Tablets 5mg Ampoules 10mg/1ml*, 35mg/3.5ml*, 50mg/5ml*, 50mg/1ml orphine sulphate R tablets 5mg, 10mg, 15mg, 30mg, 60mg, 100mg, 200mg Approved: substitution treatment in opioid dependence Approved Restricted use: off label use in substitution treatment in opioid dependence Approved- Restricted use (SS Consultant approval): off label* / substitution treatment in opioid dependence Approved Restricted use: Off-label use for detoxification in opioid dependence following chronic pain management. SS only initiation ICE(CG52);(TA114) SS only initiation ICE(CG52); SS only initiation or following Trust protocol: Opiate Addiction - anagement of hospital inpatients Concentrated oral solution (SS) restricted use only ICE(CG52);(TA114) SS only Restricted use only (travel where liquid volume an issue) ICE(TA114) SS Consultant only initiation * reparations not licensed for use in opioid dependence SS only initiation Restricted use only (jointly managed chronic pain clients) TRUST EDICIES FORULARY_HA05_January 2017_V13
Hypnotics BF section 4.11 Antispasmodics BF section 1.2 altrexone Tablet 50mg Approved: relapse prevention in opioid dependence Zopiclone Tablet 3.75mg, 7.5mg Approved: insomnia during opioid withdrawal ebeverine Tablet 135mg Approved: off label use for abdominal cramps due to opioid withdrawal Hyoscine butylbromide Tablet (Buscopan ) 10mg Approved: abdominal cramps due to opioid withdrawal SS only initiation ICE(TA115) Antimotility drugs BF section1.4.1 Drugs used in nausea & vertigo BF section 4.6 Analgesics BF section 4.7 SAID BF section 10.1.1 Co-phenotrope Tablet 2.5/0.025 (diphenoxylate 2.5mg, atropine 25 microgram) Approved: diarrhoea due to opioid withdrawal Loperamide Tablet 2mg Approved: diarrhoea due to opioid withdrawal etoclopramide Tablet 10mg Approved: nausea & vomiting due to opioid withdrawal aracetamol Ibuprofen Tablets 500mg Dispersible tablets 500mg Tablets 200mg, 400mg, 600mg Approved: aches and pains due to opioid withdrawal Approved: aches and pains due to opioid withdrawal Dispersible tablets higher cost R tablet should not be prescribed higher cost Dexamphetamin e dependence Dexamphetamine CD Tablets 5mg Approved - Restricted use (Consultant Approval): Dexamphetamine detoxification SS Consultant only initiation Restricted use in patients previously prescribed and currently dependent on dexamphetamine Gamma-hydroxy butyrate (GHB) dependence Diazepam All oral preparations Approved: off-label use in treatment of GHB withdrawal symptoms Baclofen Tablets 10mg Approved: off-label use in treatment of GHB withdrawal symptoms TRUST EDICIES FORULARY_HA05_January 2017_V13
4.11 Drugs for Dementia Acetylcholinest erase inhibitors Donepezil Galantamine Rivastigmine Tablets 5mg, 10mg Tablet orodispersible 5mg, 10mg Tablet 8mg, 12mg Capsule R 8mg, 16mg, 24mg Solution 4mg/ml Capsule 1.5mg, 3mg, 4.5mg, 6mg atch 4.6mg/24hrs, 9.5mg/24hrs Approved (1 st line option): mild to moderate dementia in Alzheimer s disease, off-label use in severe dementia where continued benefit to treatment; off-label use for BSD in dementia with Lewy Body Approved (1 st line option): mild to moderate dementia in Alzheimer s disease, off-label use in severe dementia where continued benefit to treatment; off-label use for BSD in dementia with Lewy Body Approved (1 st line option): mild to moderate dementia in Alzheimer s disease, off-label use in severe dementia where continued benefit to treatment; off-label use for BSD in dementia with Lewy Body SAH initiation only ICE(CG42);(TA217) SAH initiation only ICE(CG42);(TA217) SAH initiation only ICE(CG42);(TA217) Glutamate antagonist emantine Tablets 10mg, 20mg Approved (2nd line option): moderate and severe dementia Alzheimer s disease where AChEI not tolerated or contraindicated. SAH initiation only ICE(CG42);(TA217) 15.1.7 Antagonists for Central & Respiratory Depression Benzodiazepine antagonist Flumazenil Injection 100microgram/ml (5ml amp) Approved: off-label use for overdosage with benzodiazepines Slow intravenous injection ICE(CG25) Opioid antagonist aloxone Injection Approved: overdosage with opioids TRUST EDICIES FORULARY_HA05_January 2017_V13