Produced in collaboration with Lancashire Commissioning Support Unit.
Formulary status
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General prescribing: the medication can be initiated by any medical prescriber within the Trust. Non-medical prescribers may prescribe where this is within an individual’s competence and it is permitted by local protocol and a clinical management plan or personal formulary.
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Consultant only: the medication can only be initiated with the approval of the consultant. The consultant does not have to write the prescription there must be evidence in the notes that the request has come from the consultant or they have been consulted and there is an acceptance that treatment with the medication is appropriate. If a patient is admitted on the medication then supply will be maintained, however a review as to the appropriateness of the medication should occur. The consultant should be in agreement that medication should continue and this should be documented in the notes.
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Non-formulary: medication should not be initiated by any prescriber. If a patient is admitted on the medication, or it is already prescribed then supply will be maintained pending a review by the consultant. If it is felt that treatment should continue this should be documented in the notes and reasons for the decision given. In the case of anxiolytics and hypnotics prescribed long term, treatment will be automatically maintained long term to prevent withdrawal symptoms. For some medication deemed non-formulary there are special arrangements to request the medication where particular extenuating circumstances exist. Details of how these requests should be made are contained within the comments section
Medication is categorised according to formulary status rather than alphabetically.
All medicines available for prescribing in the BNF are referenced within the formulary document for completeness, but non-formulary drugs in LSCft have been assigned a black traffic light.
Any consultant who feels that the status of a drug should be reviewed should make a request in writing to the Chair of the Drugs and Therapeutics committee giving their reasons for the request.
Primary Care RAG status
- Green: the medication can be initiated by any general practitioner according to formulary decisions
- Amber: medication must be initiated by a hospital or GP specialist. GPs can prescribe thereafter
- Amber shared care: medication must be initiated by a hospital or GP specialist. GP’s can prescribe thereafter but a shared care document exists to support transfer of prescribing back to primary care after an agreed period and when the patient is deemed to be stable. The shared care document outlines responsibilities of both primary and secondary care
- Red: medication is initiated by secondary care. Prescribing must remain in secondary care
- Black: not suitable for prescribing
- Grey: currently under review.
Information about the Primary Care RAG Status is found on the Lancashire Medicines Management Group website.
Hypnotic Guidance Notes
General principles
- Manage the underlying cause where one has been identified. Non-drug interventions i.e. sleep hygiene measures should be considered prior to prescribing pharmacological therapy
- Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress
- Hypnotics should only be used short-term (two to four weeks)
- If patients are admitted on non-formulary hypnotics known to have a potential for dependence then the non-formulary medication will be supplied to prevent withdrawal effects. A clinical review will then consider the appropriateness or otherwise of maintaining the medication.
- NICE guidance advises that if patients do not respond to one z-hypnotic there is no indication for prescribing an alternative z-drug
Further prescribing information can be accessed from the electronic medicines compendium or the British National Formulary website.
Associated NICE guidance is available on the NICE website.
Hypnotics
Formulation: tablets
Licensed Indications:
- Insomnia and sedation in adults
- Allergic conditions
- Antiemetic
LSCft Formulary Status:
- General Prescribing LSCft injection for rapid tranquilisation
- Non-formulary tablets for insomnia
Primary Care RAG Rating: Red - Injection and Tablets (for insomnia)
Comments: Joint Formulary Committee of the BNF considers it less suitable for prescribing than alternatives for insomnia. Recommended as an option for Rapid Tranquillisation by NICE.
Formulation: Tablets, oral solution
Licensed Indications:
- Insomnia (short term use)
- Benzodiazepines only indicated where disorder is severe, disabling or subjecting the individual to extreme distress the perioperative use
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: Schedule 3 controlled drug. Subject to safe storage requirements.
Formulation: Tablets
Licensed Indications:
- Insomnia (short-term use)
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: Schedule 4 part 1 controlled drug
Formulation: MR Tablets, tablets
Licensed Indications:
- Insomnia in those over 55 (short term use only)
LSCft Formulary Status:
- General prescribing LSCft CAMHS services
- Non-formulary adults
Primary Care RAG Rating:
- MR Tablets - Grey
- Tablets for children and adults with an LD and neurodevelopmental disorders - Amber0
- Adults with ADHD - Black
- Children with ADHD already established on melatonin treatment, refer to local commissioning arrangements for ongoing review and supply - Red
- Melatonin for children and adolescents with sleep disorders secondary to ADHD - Red
- Insomnia in those over 55 (short term use only) - Black
Comments: Used on an unlicensed basis for sleep-onset insomnia and delayed sleep phase syndrome in children and adolescents, as per the BNF for children. Circadin should be prescribed in children as this is licensed in another patient population. Should an unlicensed formulation be required e.g. capsules for initial insomnia following a trial of crushed circadian a request must be submitted to the Chief Pharmacist RAG rating currently under review for neurodevelopmental disorders.
Formulation: tablets
LSCft Formulary Status: Consultant initiation only
Primary Care RAG Rating:
- For mood disorders – Amber0
- Anxiety (off label) - Green
- For epilepsy – Amber0
Comments: Used in Insomnia/Rapid Eye movement sleep behavior; Unlicensed indication, however, Clonazepam is the treatment of choice.
Formulation: tablets, oral suspension
Licensed Indications: Insomnia (short-term use)
LSCft Formulary Status: Consultant initiation only
Primary Care RAG Rating: Insomnia (short-term use) - Amber 0
Comments: Long half-life with problems associated with hangover effect the following morning/risk of falls in the elderly.
Formulation: tablets, elixir, mixture
Licensed Indications: Insomnia (short-term use)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Insomnia (short-term use) - Black
Comments: Joint Formulary Committee of the BNF considers it less suitable for prescribing than alternatives.
Formulation: Capsules
Licensed Indications: Insomnia (short-term use)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Insomnia (short term use) - Black
Comments: NHS blacklisted so only available on a private prescription.
Formulation: tablets
Licensed Indications: Insomnia (short-term use)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Insomnia (short term use) - Black
Formulation: tablets
Licensed Indications: Insomnia (short-term use)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Insomnia (short-term use) - Black
Formulation: Solution
Licensed Indications: Narcolepsy with catalepsy
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Insomnia (short term use) - Black
Formulation: capsules
Licensed Indications: Insomnia (short-term use)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Insomnia (short-term use) - Black
Formulation: tablets
Licensed Indications: Insomnia (short-term use)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Insomnia (short-term use) - Green
Anxiolytic guidance notes
Formulary status of anxiolytic drugs
General principles
- Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic or psychotic illness
- The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate and unsuitable
- Benzodiazepines should not be used to treat panic disorder
- If patients are admitted on non-formulary benzodiazepines or barbiturates then the non-formulary medication will be supplied to prevent withdrawal effects. A clinical review will then consider the appropriateness or otherwise of maintaining the medication.
Further prescribing information can be accessed from the electronic medicines compendium or eBNF website.
Associated NICE guidance is available on their website.
The British Association for Psychopharmacology have produced guidelines on the management of anxiety.
Anxiolytic
Formulation: tablets
Licensed Indications: Anxiety (short-term use)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Anxiety (short-term use) - Black
Comments: NHS blacklisted
Formulation: tablets, capusules
Licensed Indications: Severe intractable insomnia only in patients already taking barbiturates
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Comments: Joint Formulary Committee of the BNF considers it less suitable for prescribing than alternatives. Named patient.
Formulation: tablets
Licensed Indications: Anxiety (short-term use)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Anxiety (short-term use) - Black
Formulation: tablets, capsules
Licensed Indications:
- Anxiety (short-term use)
- Adjunct in acute alcohol withdrawal
LSCft Formulary Status:
- General Prescribing LSCft for alcohol withdrawal
- Non-Formulary for anxiety
Primary Care RAG Rating:
- Anxiety – Black
- Alcohol withdrawal - Red
Formulation: tablets, liquid
Licensed Indications: Not licensed but noted in the BNF panic disorder (with or without agoraphobia) resistant to an antidepressant
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Anxiety (off label) - Green
Formulation: tablets, solution injection, rectal tubes, suppositories
Licensed Indications: short-term use in anxiety or insomnia, adjunct in alcohol withdrawal
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Anxiety - Green
Formulation: tablets, injection
Licensed Indications: short-term use in anxiety and insomnia
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating:
- Tablets short-term use in anxiety and insomnia – Green
- Injection - Red
Comments: Lorazepam injection is included in the trust rapid tranquillisation policy (CL008).
Formulation: tablets
Licensed Indications: short-term use in anxiety
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Anxiety (short-term use) - Black
Comments: Joint Formulary Committee of the BNF considers it less suitable for prescribing than alternatives.
Formulation: tablets
Licensed Indications: Anxiety (short-term use)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Anxiety (short-term use) - Black
Formulation: capsules
Licensed Indications: Generalised anxiety disorder
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Generalised anxiety disorder - Black
Comments: Non-formulary for generalised anxiety disorder. Medication will be supplied in LSCft for those initiated or maintained on this for other licensed indications, or those patients where the specialist affective disorders clinic has recommended its use.
Formulation: tablets, liquid
Licensed Indications: Anxiety with symptoms such as palpitation, sweating, tremor
LSCft Formulary Status: Consultant initiation only
Primary Care RAG Rating: Anxiety - Green
Comments: Note: significant risks when taken in overdose. Potential for rapid deterioration before medical assistance is received.
1st Gen Antipsychotic Guidance
Formulary status of First Generation (typical) antipsychotic drugs
Further prescribing information can be accessed from the electronic medicines compendium or eBNF website.
Associated NICE guidance is available on their website.
Psychosis and schizophrenia in adults: prevention and management Clinical guideline 178. It is important to note that this guidance clearly states the following:
“Do not initiate regular combined antipsychotic medication, except for short periods (for example, when changing medication). If a combination is indicated then this should be an evidence based combination and there must be a rationale documented in the notes and regular reviews of efficacy and side effects. If the combination represents high dose therapy then the procedure for the prescribing and Monitoring of High Dose Antipsychotics PHA 039 must be consulted and appropriate monitoring completed."
Information regarding monitoring is available in the SOP for Psychotropic Drug Monitoring Policies.
1st Gen Antipsychotic
Formulation: tablets
Licensed Indications: control of deviant antisocial sexual behaviour
LSCft Formulary Status: Consultant initiation only
Primary Care RAG Rating: Red - for new patients
Comments: has no license for schizophrenia.
Formulation: tablets, liquid, oral suspension
Licensed Indications: Schizophrenia and other psychoses, mania, hypomania anxiety, agitation, violent or dangerously impulsive behaviour, childhood schizophrenia and autism
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Formulation: injection
Licensed Indications: Schizophrenia and other psychoses, mania, anxiety, agitation, violent or dangerously impulsive behaviour, childhood schizophrenia
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Comments: does not constitute rapid tranquillisation and must not be used.
Formulation: tablets
Licensed Indications: Schizophrenia and other psychoses
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating:
- Green
- Depressive illness, psychoses - Black
Formulation: depot injection
Licensed Indications: maintenance in schizophrenia and other psychoses
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Formulation: depot injection
Licensed Indications: maintenance in Schizophrenia and other psychoses
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Comments: Licensed product no longer available. Where patients have deteriorated following a switch to an alternative depot antipsychotic a request can be made to use the unlicensed product should be made to the Lead Pharmacist in the locality.
Formulation: tablets, liquid
Licensed Indications: Schizophrenia and other psychoses, mania, severe anxiety, psychomotor agitation, violent
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: Link to Rapid Tranquillisation Procedure.
Formulation: injection
Licensed Indications: rapid tranquilisation
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Red
Comments: Link to Rapid Tranquillisation Procedure. Haloperidol injection should be used in combination with Promethazine injection for rapid tranquillisation.
Formulation: injection
Licensed Indications: maintenance in Schizophrenia and other psychoses
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Formulation: tablets, injection
Licensed Indications: Schizophrenia
LSCft Formulary Status: Consultant initiation only
Primary Care RAG Rating:
- Existing patients - Amber 0
- New patients - Black
Comments: Risk of postural hypotension. Not recommended for ambulant patients over the age of 50. May be prescribed for nausea and vertigo.
Formulation: tablets, syrup
Licensed Indications: Schizophrenia and other psychoses, short-term management of severe anxiety, psychomotor agitation, violent or dangerously impulsive behaviour
LSCft Formulary Status: consultant initiation only
Primary Care RAG Rating: Black
Formulation: tablets, injection, suppositories
Licensed Indications: Schizophrenia and other psychoses, mania, short-term management of severe anxiety
LSCft Formulary Status: consultant initiation only
Primary Care RAG Rating: Black
Comments: May be prescribed for antiemetic purposes.
Formulation: tablets, solution
Licensed Indications: short-term management of psychomotor agitation, agitation and restlessness in the elderly
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: Joint Formulary Committee of the BNF considers it less suitable for prescribing than alternatives.
Formulation: tablets, liquid
Licensed Indications: Schizophrenia
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Not listed
Formulation: tablets, liquid
Licensed Indications: Schizophrenia and other psychoses, short-term management of severe anxiety, psychomotor agitation, violent or dangerously impulsive behaviour, severe anxiety. Not to be used in psychotic depression.
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Formulation: injection
Licensed Indications: short-term management of acute psychosis, mania or exacerbations of chronic psychosis
LSCft Formulary Status: consultant initiation only
Primary Care RAG Rating: Red
Comments: Does not constitute rapid tranquilisation and must not be routinely used. Link to LSCft procedure on use of Zuclopenthixol Acetate.
Formulation: injection
Licensed Indications: maintenance in Schizophrenia and other psychoses
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Formulation: tablets
Licensed Indications: Schizophrenia and other psychoses
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
2nd Gen Antipsychotic Guidance
Formulary status of Second Generation (atypical) antipsychotic drugs
Further prescribing information can be accessed from the electronic medicines compendium or eBNF website.
Associated NICE guidance is available on their website.
Psychosis and schizophrenia in adults: prevention and management Clinical guideline 178. It is important to note that this guidance clearly states the following:
“Do not initiate regular combined antipsychotic medication, except for short periods (for example, when changing medication). If a combination is indicated then this should be an evidence-based combination and there must be a rationale documented in the notes and regular reviews of efficacy and side effects. If the combination represents high dose therapy then the procedure for the prescribing and Monitoring of High Dose Antipsychotics PHA 039 must be consulted and appropriate monitoring completed.”
Information regarding monitoring is available in the SOP for Psychotropic Drug Monitoring Policies.
Clozapine and Risperidone long-acting injection, Paliperidone long-acting injection and Aripiprazole long-acting injection are ‘hospital only’ and GP’s must not be asked to prescribe.
2nd Gen Antipsychotic
Formulation: tablets, liquid
Licensed Indications: Schizophrenia
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 1
Formulation: tablets, orodispersible tablets, oral solution
Licensed Indications:
- Schizophrenia in adults and adolescents 15 years and older, moderate to severe manic episodes in Bipolar 1 Disorder, prevention of a new manic episode in patients who experienced predominantly manic episodes and whose manic episodes respond to Aripiprazole treatment
- 12 weeks in severe manic episodes in Bipolar 1 in adolescents over 13 years and over (up to 12 weeks treatment in adolescents), prevention of a new manic episode in patients who experienced predominantly manic episodes and whose manic episodes respond to Aripiprazole treatment
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating:
- Schizophrenia and Bipolar disorder in adults - Amber 1
- Bipolar in adolescents - Red
Comments: NICE bipolar guidelines do not recommend aripiprazole for the treatment of mania or hypomania.
Formulation: long-acting Injection
Licensed Indications: Schizophrenia in adult patients stabilised on oral Aripiprazole
LSCft Formulary Status: restricted use only
Primary Care RAG Rating: Red
Comments: Application from RMO to be sent to Chief Pharmacist and Medical Director requesting its use. The application form can be found on the pharmacy intranet page on TrustNet.
Formulation: short acting injection
Licensed Indications: Rapid control of agitation and disturbed behaviours in adult patients with Schizophrenia or with manic episodes in Bipolar 1 Disorder, when oral therapy is not appropriate. Treatment should be discontinued as soon as clinically appropriate and the use of oral Aripiprazole should be initiated.
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Not listed
Comments: The use of Aripiprazole short-acting injection as an alternative where the patient refuses oral treatment should be in extremis and is an off label indication for the drug. Monitoring would be required as per rapid tranquilisation. NICE does not currently support the use of Aripiprazole injection as rapid tranquilisation.
Formulation: Capsules
Licensed Indications: treatment of Schizophrenia in adults.
LSCft Formulary Status: restricted use only
Primary Care RAG Rating: Amber 1
Comments: Second-line therapy in patients where predominantly negative symptoms have been identified as an important feature. Requires prior approval before initiation, link to Cariprazine application form is available on the pharmacy intranet page.
Formulation: tablets
Licensed Indications: treatment resistant/intolerant Schizophrenia Psychosis in Parkinson’s disease
LSCft Formulary Status: consultant initiation only
Primary Care RAG Rating: Red
Comments: Link to CSM advice re constipation link to CSM advice re cardiomyopathy and myocarditis link to Clozapine plasma level guidelines.
Formulation: tablets
Licensed Indications: Treatment of schizophrenia in adults and adolescents aged 13 years and over
LSCft Formulary Status: restricted use only
Primary Care RAG Rating: Red
Comments: Lurasidone will be supplied by the specialist service for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Lurasidone may only be prescribed in the following circumstances:
1. The patient has previously had a trial of and has not responded to Aripiprazole
2. The patient does not fulfil the treatment resistance criteria as outlined in NICE Clinical Guideline 178 for the initiation of prescribing of Clozapine
3. The patient has:
a. a metabolic disorder, diabetes or obesity or
b. pre-existing risk factors for metabolic disease, diabetes or obesity
All requests for lurasidone will be screened by LSCft
Formulation: tablets, orodispersible tablets, injection
Licensed Indications:
- Schizophrenia and moderate to severe manic episodes and preventing reoccurrence in Bipolar Disorder
- Injection: rapid tranquillisation
LSCft Formulary Status: general prescribing LSCft injection as 3rd line option as per Rapid Tranquillisation Procedure
Primary Care RAG Rating:
- Oral - Amber 1
- Injection - Red
Comments: A licensed product of Olanzapine injection is no longer available in the UK. Olanzapine injection is no longer recommended as a treatment option in the NICE guidance on violence.
Formulation: long-lasting injection
Licensed Indications: maintenance treatment of adult patients with Schizophrenia sufficiently stabilised during acute treatment with oral Olanzapine
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Formulation: tablets
Licensed Indications: Schizophrenia
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Formulation: long-acting injection
Licensed Indications: Schizophrenia
LSCft Formulary Status: restricted use only
Primary Care RAG Rating: Red
Comments: For the monthly injection (Xeplian) and for Aripirazole LAI :Application from RMO to be sent to Chief Pharmacist and Medical Director requesting its use. Link to application form. The three monthly injection (Trevicta) if approval has been given for the monthly paliperidone depot there is no requirement for a further request to be sent to request a move to the three monthly option.
Formulation: tablets
Licensed Indications: Schizophrenia, manic episodes associated with Bipolar Disorder, major depressive episodes in Bipolar Disorder, preventing recurrence in Bipolar Disorder
LSCft Formulary Status: general Prescribing LSCft
Primary Care RAG Rating: Amber 1
Formulation: tablets
Licensed Indications: as quetiapine plus adjunct in Major Depressive Disorder
LSCft Formulary Status: restricted use only
Primary Care RAG Rating: Amber 1
Comments: restricted formulary: approval should be sought from Locality Lead Pharmacist prior to initiation.
Formulation: tablets, liquid, quicklet
Licensed Indications: Schizophrenia, moderate to severe manic episodes associated with bipolar disorders, short-term treatment (up to 6 weeks) of persistent aggression in patients with moderate to severe Alzheimer's Dementia unresponsive to non-pharmacological approaches and when there is a risk of harm to self or others, short-term symptomatic treatment (up to 6 weeks) of persistent aggression in conduct disorder in children from the age of 5 years and adolescents with subaverage intellectual functioning or mental retardation diagnosed according to DSM-IV criteria, in whom the severity of aggressive or other disruptive behaviours require pharmacologic treatment
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 1
Comments: may be used for longer periods (off-label) in Conduct Disorder with Autistic Spectrum Condition or severe learning disability.
Formulation: long-acting injection
Licensed Indications: Schizophrenia
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Red
Comments: Link to Trust prescribing guidelines
Formulation: tablets
Licensed Indications: Schizophrenia (not first line)
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Mood Stabiliser Guidance
Formulary status of mood stabilisers general principles
- Antipsychotic medication with mood stabilising properties will be considered in the formulary section for second generation antipsychotics
- Clonazepam is very occasionally used (unlicensed) in cases of treatment resistant mania. Ensure regular review, gradual reduction where the benzodiazepine has been used longer-term Patients prescribed mood stabilisers need to be monitored as described in the associated NICE guideline and LSCft monitoring guidelines
- Lithium is subject to shared care arrangements and must be prescribed by LCFT for at least three months and until the patient is stable
- Valproate preparations are associated with teratogenic effects and are subject to an MHRA alert.
Further prescribing information can be accessed from the electronic medicines compendium or eBNF website.
Associated NICE guidance is available on their website.
Mood Stabilisers
Formulation: sublingual tablets
Licensed Indications: acute mania
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Formulation: tablets, liquids suppositories
Licensed Indications: prophylaxis of Bipolar Disorder unresponsive to Lithium.
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Formulation: tablets, dispersible tablets
Licensed Indications: Bipolar Disorder
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Comments: Note: interaction with sodium valproate requires careful titration. Refer to SPC for further information.
Formulation: tablets (generally Priadel brand), liquid
Licensed Indications: treatment and prophylaxis of mania, Bipolar Disorder and recurrent Depression. Aggressive or self-mutilating behaviour.
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 1
Comments: Due to differences in bioavailability prescribing should be by brand name. For new patients Priadel is recommended. Lithium carbonate 200mg is equivalent to Lithium citrate 509mg. Note: interactions with NSAID’s, diuretics, ACE inhibitors. See SPC for full list.
Formulation: tablets
Licensed Indications: Manic episodes associated with Bipolar Disorder
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Comments: contraindicated in females of child bearing potential unless the conditions of Prevent are fulfilled.
Formulation: tablets, liquid
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Comments: Unlicensed as a mood stabiliser. Contraindicated in females of child bearing potential unless the conditions of Prevent are fulfilled.
Antidepressant guidance
Formulary status of antidepressant general principles
- Care should be taken when switching between antidepressants. Washout periods are always required with MAOI’s. Contact pharmacy for further advice if required.
- Advise patients of the delayed response, need for ongoing treatment once symptoms resolve and risk of discontinuation reactions if medication is not taken regularly or stopped suddenly.
Further prescribing information can be accessed from the electronic medicines compendium or eBNF website.
Associated NICE guidance is available on their website.
Antidepressants
Formulation: tablets
Licensed Indications: Major Depression
LSCft Formulary Status: restricted use
Primary Care RAG Rating: Red
Comments: Link to prescribing guidelines. Requirement for close monitoring of liver function tests. Prior approval required from LSCft medical director/chief pharmacist before prescribing within LSCft. Prescribing to remain in secondary care.
Formulation: tablets, oral solution
Licensed Indications: Depressive illness
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: consider overdose risk.
Formulation: tablets, oral drops
Licensed Indications: depressive illness, Panic Disorder
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: 8mg oral drops is equivalent to 10mg tablet. Lower incidence of drug interactions than some other SSRI’s.
Formulation: capsules, modified release tablets
Licensed Indications:
- Depressive illness
- phobic and obsessional states
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating:
- Capsules – Green
- MR Tabs - Black
Comments: consider overdose risk. MR tablets are considered by the Joint Formulary Committee for the BNF to be less suitable for prescribing.
Formulation: tablets, capsules
Licensed Indications: depressive illness
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Comments: Risks felt to outweigh benefits due to high toxicity in overdose. Not recommended by NICE.
Formulation: capsules
Licensed Indications: depressive illness
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Amber 0
Comments: Consider overdose risk.
Formulation: capsules
Licensed Indications:
- Depressive illness
- Generalised Anxiety Disorder
LSCft Formulary Status: general prescribing LSCft not first line
Primary Care RAG Rating: Green
Comments: Link to LCT prescribing guidelines. Third line use within LSCft. Caution: available as another brand Yentreve for stress urinary incontinence. Recommended that prescriptions state the brand name Cymbalta.
Formulation: tablets, oral drops
Licensed Indications:
- Depressive illness
- Panic Disorder
- Generalised Anxiety Disorder
- Obsessive Compulsive Disorder
- Social Anxiety Disorder
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green - restricted
Comments: available for consultant initiation in Generalised Anxiety Disorder but only after Sertraline has been tried.
Formulation: capsules, liquid
Licensed Indications:
- Depressive illness
- Bulimia Nervosa
- Obsessive Compulsive Disorder
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: first line for children and adolescents. Higher propensity for drug interactions.
Formulation: tablets
Licensed Indications:
- depressive illness
- psychoses
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Formulation: tablets
Licensed Indications:
- depressive illness
- Obsessive Compulsive Disorder
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Comments: higher propensity for drug interactions.
Formulation: tablets
Licensed Indications: depressive illness
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: consider overdose risk.
Formulation: tablets
Licensed Indications: depressive illness
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Formulation: tablets
Licensed Indications: depressive illness
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: less cardiotoxicity and lower risk in overdose compared with other tricyclic antidepressants.
Formulation: tablets
Licensed Indications: depressive illness
LSCft Formulary Status: consultant initiation only
Primary Care RAG Rating: Amber 0
Comments: due to risks of neutropenia and agranulocytosis a full blood count is recommended every 4 weeks.
Formulation: tablets, soltabs
Licensed Indications: depressive illness
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Formulation: capsules
Licensed Indications:
- depressive illness
- social phobia
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Comments: week for the first three month treatment.
Formulation: tablets
Licensed Indications:
- depressive illness
- neuropathic pain
LSCft Formulary Status: non-formulary
Primary Care RAG Rating:
- Green (restricted) for neuropathic pain
- Black - for depressive illness
Comments: consider overdose risk.
Formulation: tablets, liquid
Licensed Indications:
- depressive illness
- Post-traumatic Stress Disorder
- Obsessive Compulsive Disorder
- Panic Disorder
- Social Phobia
- Generalised Anxiety Disorder
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: higher risk of discontinuation reactions. Higher propensity for drug interactions.
Formulation: tablets
Licensed Indications: depressive illness
LSCft Formulary Status: consultant initiation only
Primary Care RAG Rating: Amber 0
Comments: caution: many interactions with other medication, food and drink. Refer to SPC. Washouts required when changing to and from Phenelzine.
Formulation: tablets
Licensed Indications: depressive illness
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Comments: not licensed in the elderly.
Formulation: tablets
Licensed Indications:
- depressive illness
- Obsessive Compulsive Disorder (under specialist supervision in children)
- Post Traumatic Stress Disorder
- Panic Disorder
- Social Anxiety Disorder
LSCft Formulary Status: general prescribing LSCft
Comments: NICE recommend first line for Generalised Anxiety Disorder (unlicensed). Lower incidence of drug interactions than some other SSRI’s.
Formulation: tablets
Licensed Indications: depressive illness
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Formulation: capsules, liquid
Licensed Indications: depressive illness
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: consider overdose risk.
Formulation: capsules
Licensed Indications: depressive illness
LSCft Formulary Status: non-formulary
Primary Care RAG Rating: Black
Formulation: tablets
Licensed Indications: hospital specialist initiation only for patients with severe and disabling depressive illness of more than 2 years continuous duration, after an adequate trial of standard antidepressant treatment and only as an adjunct to other antidepressant medication
LSCft Formulary Status: consultant initiation only
Primary Care RAG Rating: Amber 1
Comments: rare side effect of eosinophilia-myalgia syndrome. No longer a requirement for patients to be registered with the OPTICS unit and have routine full blood counts. Must be initiated by a hospital specialist although general practitioners can subsequently prescribe. Subject to shared care so LSCft must prescribe for a minimum of three months and until stable.
Formulation: tablets, capsules XL
Licensed Indications:
- depressive illness
- Generalised Anxiety Disorder (XL formulation only)
LSCft Formulary Status: general prescribing LSCft third line
Primary Care RAG Rating: Green
Comments: third line use only. Consider cardiovascular history e.g. uncontrolled hypertension, and risk of overdose. Higher propensity for discontinuation.
Formulation: tablets
Licensed Indications: major depressive episodes in adults
LSCft Formulary Status: consultant initiation only third line
Primary Care RAG Rating: Green
Comments: third line use only in line with the nice technology appraisal (ta367).
Dementia Drugs Guidance
Formulary status of drugs for dementia general principles
Prescribing is initiated in line with recommendations in the National Institute for Clinical Excellence (NICE) Technology appraisal 111, Donepezil, Galantamine, Rivastigmine and Memantine for the treatment of Alzheimer’s disease.
Further prescribing information can be accessed from the electronic medicines compendium or eBNF website.
Associated NICE guidance is available on their website.
Dementia
Formulation: tablets, orodispersible tablets
Licensed Indications: mild to moderate dementia in Alzheimer’s disease
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Formulation: tablets, XL capsules, oral solution
Licensed Indications: mild to moderate dementia in Alzheimer’s disease
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Formulation: tablets, oral drops
Licensed Indications:
- severe dementia in Alzheimer’s disease
- moderate Alzheimer’s disease with intolerance or contraindication to acetylcholinerase inhibitors
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
Formulation: capsules, oral solution, transdermal patches
Licensed Indications: mild to moderate dementia in Alzheimer’s disease and Parkinson’s disease
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 0
ADHD drugs Guidance notes
Formulary status of drugs for Attention Deficit Hyperactivity Disorder (ADHD) General Principles
Prescribing is initiated in line with recommendations in the National Institute for Clinical Excellence (NICE) Clinical Guideline 72 Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults.
LSCft must maintain prescribing responsibilities for a minimum period of three months and until response and tolerability have been assessed, as per shared care arrangements.
Further prescribing information can be accessed from the electronic medicines compendium or eBNF website.
Associated NICE guidance is available on their website.
ADHD
Formulation: capsules
Licensed Indications: Attention deficit disorder in children and adults with preexisting symptoms of ADHD in childhood
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 1
Formulation: tablets
Licensed Indications: prevention of recurrent migraine, vascular headache; Tourette syndrome [unlicensed]; hypertension; menopausal flushing; sedation [unlicensed]
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Red - for ADHD
Comments: third line for ADHD e.g. Tourettes with ADHD, nonresponse to licensed alternatives, other medications unsuitable e.g. weight concerns or other risk factors.
Formulation: tablets
Licensed Indications: narcolepsy; attention deficit hyperactivity disorder in children aged 6 years and over when response to previous methylphenidate treatment is considered clinically inadequate
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 1
Formulation: prolonged release tablets
Licensed Indications: ADHD in children and adolescents aged 6 to 17 years for whom stimulants are not suitable, not tolerated or have been shown to be ineffective
LSCft Formulary Status: consultant initiation only
Primary Care RAG Rating: Amber 1
Comments: this shared care status applies just to children and adolescents.
Formulation: capsules
Licensed Indications:
- Attention Deficit Hyperactivity Disorder in children aged 6 years and over when response to previous Methylphenidate treatment is considered clinically inadequate
- Adult ADHD: Lisdexamfetamine is recommended as an option for use as part of a comprehensive treatment programme for attention deficit/hyperactivity disorder (ADHD) in adults when used in line with the agreed treatment algorithm
LSCft Formulary Status: general prescribing LSCft adults and children in line with treatment algorithm
Primary Care RAG Rating: Amber 1
Formulation: immediate or modified release tablets or capsules
Licensed Indications:
- Attention deficit hyperactivity disorder (under specialist supervision)
- Narcolepsy [unlicensed indication]
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Amber 1
Comments: different versions of modified-release preparations may not have the same clinical effect. To avoid confusion between these different formulations of Methylphenidate, prescribers should specify the brand to be dispensed.
Formulary status of anticholinergic drugs for management of side effects with antipsychotic medication
Further prescribing information can be accessed from the electronic medicines compendium or eBNF website.
Associated NICE guidance is available on their website.
Anticholinergic drugs
Formulation: tablets
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Comments: used off label in the management of clozapine-induced hypersalivation.
Formulation: tablets
Licensed Indications: control of extrapyramidal symptoms induced by neuroleptic drugs
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: not listed
Formulation: tablets
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: not listed
Comments: unlicensed medicine used for clozapine-Induced hypersalivation.
Formulation: tablets
Licensed Indications: control of extrapyramidal symptoms induced by neuroleptic drugs
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
Formulation: tablets
Licensed Indications: control of extrapyramidal symptoms induced by neuroleptic drugs
LSCft Formulary Status: general prescribing LSCft
Primary Care RAG Rating: Green
You can view the Joint Formulary for Psychotropic Medication in an Excel document but please note that this does not meet accessibility standards.