Download Formulary 2016 - South West London and St George`s Mental

TRUST MEDICINES FORMULARY
This Formulary details those psychotropic medicines that may be prescribed within the Trust (on hospital prescriptions and FP10s) and
recommended to be prescribed across South West London and should be read in conjunction with the Shared care for Psychotropics with
Primary care and the ‘off-label’ policies.
The Formulary contains:
 formulations that are available within the Trust
 prescribing restrictions / guidelines that apply to that medicine within the Trust
 additional information pertinent to the safe & effective use of the medicine
 Medicines in the same order as the British National Formulary (BNF), with headings
 Only psychotropic medicines (see local Hospital Formularies for medicines for physical complaints).
 Nicotine replacement treatments follow Wandsworth CCG formulary (includes bupropion and varenicline and other treatments)
 Compliance with NICE Technology Appraisal Guidance.
Non-formulary
psychotropic medicines
Agomelatine
Aripiprazole Depot
Asenapine
Duloxetine
Escitalopram (except
OCD/BDD)
Loxapine inhalation
Lurasidone
Olanzapine palmoate
Oxazepam
Paliperidone (oral)
Medicines removed from the
formulary:
Benperidol -July 2010
Benzatropine -July 2011
Chloral hydrate -Nov 2009
Chlormethiazole –Sept 2015
Concerta (except 27mg) –Dec
2015
Dosulepin (Dothiepin) -2007
Droperidol -2001
Melatonin (Unlicensed) –July
2011
Nefazodone -January 2003
Olanzapine short acting inj. -Dec
2013
Orphenadrine -Sept 2013
Promazine -Dec 2013
Reboxetine -July 2011
Risperidone long-acting injection April 2011
Ritalin-SR -July 2011
Temazepam -Feb 2014
Thioridazine - 2005
Zotepine - July 2011
Medicines Added to the
Formulary since April 2015:
Lisdexamfetamine –Oct 2015
Nutrition & dietetic products-Apr
2015
Vortioxetine-Feb 2016
Xenidate®-Apr 2015
Further advice & Information
 Contact your local Mental Health Pharmacist or Medicines Information on 020 3513 6829 for help and advice.
 The Trust has a formulary policy (available on the Trust’s intranet and website), and application forms for non-formulary medicines for
specific patients (SDTC2) or for inclusion in to the formulary (SDTC1) .
 Trust Prescribing guidance is available on the Medicines and Prescribing subsite, the Policies section of the intranet or website.
 See the BNF, BNFc and Manufacturers Summary of Product Characteristics for full prescribing details. Numbering refers to eBNF.
DTC Feb 2016
* If clinically indicated or another preparation if the patient insists.
3.4.1 Sedating antihistamines
Medicine
Formulations
Promethazine hydrochloride
tablet 10mg, 25mg
liquid 5mg / 5ml
injection 25mg/mL
4.1 Hypnotics & Anxiolytics
Nitrazepam
tablet 5mg,
liquid 2.5mg / 5ml
Non-benzodiazepine hypnotics & other sedatives
Zopiclone
tablet 3.75mg
tablet 7.5mg
Zolpidem
Melatonin
4.1.2 Anxiolytics
Diazepam
Chlordiazepoxide
Lorazepam
DTC Feb 2016
tablet 5mg
tablet 10mg
tablets 2mg MR (Circadin®)
tablet 2mg, 5mg, 10mg. liquid
2mg/5ml, 5mg/5ml. injection
emulsion 5mg/ml, rectal solution
5mg, 10mg
capsule 5mg, 10mg
tablet 1mg, 2.5mg
injection: 4mg /1ml. 2mg/1ml (does
NOT require dilution)*
Restrictions
*1st line
*2nd line after zopiclone
School-age children
with developmental
disability.
Additional information
See Trust policy TWC21x
Use with caution & at lower dosage in the
elderly (see BNF)
See Trust policy TWC21x
Controlled Drug
See NICE TA77: Guidance on the use of
zaleplon, zolpidem and zopiclone for the
short-term management of insomia
Controlled Drug
See NICE TA77
Unlicensed formulations from Hospital only.
Injection (emulsion) intravenous (IV) only
For alcohol
detoxification regimens
only
IM gluteal injection only
or deltoid when safe to
do so
* If clinically indicated or another preparation if the patient insists.
4mg/1ml injection: dilute 1:1 with water for
injection / sodium chloride 0.9%
Imported from outside the EU.
4.2 Medicines used in psychoses and related disorders
4.2.1 Antipsychotic Medicines
Medicine
Chlorpromazine
Flupentixol dihydrochloride
Haloperidol
Sulpiride
Trifluoperazine
Zuclopenthixol acetate
(“Clopixol Acuphase”)
Zuclopenthixol
dihydrochloride
Atypical Antipsychotics
Amisulpride
Aripiprazole
Clozapine
DTC Feb 2016
Formulations
tablet 10mg, 25mg,
50mg, 100mg
liquid 25mg/5ml,
100mg/5ml
3mg tablet
capsule 500microg,
tablet 1.5mg, 5mg, 10mg
liquid 5mg/5ml, 10mg/5ml
injection 5mg/1ml
tablet 200mg, 400mg
liquid 200mg / 5ml
tablet 1mg, 5mg**
liquid 5mg/5ml
injection 50mg, 100mg
Restrictions
See Trust policy TWC21c.
NOT to be used for night sedation.
Hospital only: mania in Children
Additional information
Pre-treatment ECG
required
200mg tablets are 1st line
**Manufacturing delays frequent consider
switching to another medicine.
Hospital only. For use in patients requiring
or may require repeated IM injections and
are refusing oral medicines
tablet 2mg,10mg, 25mg
tablet 50mg, 200mg, 400mg
liquid 100mg / 1ml
tablet 5mg, 10mg, 15mg
orodisp tab. 10mg, 15mg injection
7.5mg in 1ml
tablet 25mg, 100mg (Zaponex)
liquid 50mg/mL (Denzapine)
*Not 1st line for any
indication
Max recommended 1015mg/day in
schizophrenia
See Trust Clozapine
Guide
* If clinically indicated or another preparation if the patient insists.
Use liquid only if doses are <2.5mg/day
See NICE TA213: Aripiprazole for the
treatment of schizophrenia in people aged
15 – 17 years
See NICE TA292: Aripiprazole for treating
moderate to severe manic episodes in
adolescents with bipolar I
Monitoring systems used: Zaponex
Treatment Access System (ZTAS) for
tablets. Denzapine Monitoring Service
(DMS) for liquid.
Medicine
Olanzapine
Quetiapine
Risperidone (oral)
Formulations
tablet 2.5mg, 5mg, 7.5mg, 10mg,
15mg, 20mg
dispers. tablet 5mg, 10mg, 15mg
tablet 25mg, 100mg, 150mg,
200mg, 300mg
M/R tablets 50mg, 200mg, 300mg,
400mg
tablet 500microg, 1mg, 2mg, 3mg,
4mg, 6mg
dispers. tablet 1mg, 2mg, 3mg,
4mg. liquid 1mg / 1ml
4.2.2. Antipsychotic Depot Injections
Flupenthixol decanoate
20mg/1ml, 40mg/2ml, 50mg/0.5ml,
100mg/1ml, 200mg/1ml.
Fluphenazine decanoate
12.5mg/0.5ml, 25mg/1ml,
50mg/0.5ml &100mg/1ml
Haloperidol decanoate
50mg/1ml, 100mg/1ml
Pipotiazine palmitate
50mg/1ml, 100mg/2ml
Zuclopenthixol decanoate
200mg/1ml, 500mg/1ml
Paliperidone palmitate
50mg, 75mg, 100mg, 150mg
DTC Feb 2016
Prescribing
restrictions
Orodispersible for
dyspahgia or supervised
administration only
Additional information
Requires twice daily dosage
1st line atypical
antipsychotic.
Orodispersible for
dyspahgia or supervised
administration only
For community team use for supervised
administration only, not for discharge.
Optimum oral dosage 4-6mg per day in
schizophrenia.
See TWC21b for administration details
Not for new initiations.
Schizophrenia: either
side effects from current
depot, compliance
problems with oral
atypical or at patient
request
* If clinically indicated or another preparation if the patient insists.
Complete monitoring form before
prescribing.
Complete SDTC2 if patient does not meet
Trust prescribing criteria.
4.2.3 Antimanic Medicines
Medicine
Formulations
Prescribing
restrictions
Carbamazepine
Lamotrigine
Sodium valproate
Lithium carbonate
Lithium citrate
Semisodium valproate
“Priadel” tablet MR 200mg, 400mg
Liquid 10.8mmol Li / 5ml (“Li-liquid”)
tablet e/c 250mg, 500mg
2nd line valproate
preparation
4.3 Antidepressant Medicines
4.3.1Tricyclic & related antidepressant Medicines
Amitriptyline
tablet 10mg, 25mg, 50mg
liquid 50mg / 5ml
Clomipramine
caps 10mg, 25mg, 50mg
Imipramine
tablet 10mg, 25mg
liquid 25mg / 5ml
Lofepramine
tablet 70mg
liquid 70mg / 5ml
Nortriptyline
tablet 10mg, 25mg
DTC Feb 2016
* If clinically indicated or another preparation if the patient insists.
Additional information
See Section 4.8 - Antiepileptic Medicines
below
See Section 4.8 - Antiepileptic Medicines
below
See Section 4.8 - Antiepileptic Medicines
below
Should not be used during pregnancy and
in women of child-bearing potential
unless clearly necessary i.e. in situations
where other treatments are ineffective or
not tolerated
(MR = modified release)
10.8mmol/5ml = 400mg lithium carbonate
Prescribe as “Depakote – semisodium
valproate” to avoid confusion with Epilim
Should not be used during pregnancy and
in women of child-bearing potential
unless clearly necessary i.e. in situations
where other treatments are ineffective or
not tolerated
Trimipramine
tablet 10mg, 25mg
capsule 50mg
Trazodone
capsule 50mg,100mg
liquid 50mg / 5ml
4.3.2 Monoamine – oxidase inhibitors (MAOIs)
 Phenelzine
tablet 15mg
 Isocarboxazid
tablet 10mg
 Tranylcypromine
tablet 10mg
Reversible MAOIs
Moclobemide
tablet 150mg
4.3.3 Selective serotonin re-uptake inhibitors
Medicine
Formulations
Citalopram
Fluoxetine
Paroxetine
Sertraline
Escitalopram
tablet 10mg, 20mg
capsule 20mg
liquid 20mg / 5ml
tablet 20mg, 30mg liquid 10mg /
5ml
tablet 50mg, 100mg
Tablet 5mg, 10mg, 20mg
4.3.4 Other antidepressant Medicines
Mirtazapine
orodispersible tablet 15mg, 30mg,
45mg
Venlafaxine
tablet 37.5mg, 75mg
MR caps (hospital only) MR 75mg,
150mg.
MR tabs (community only)
Vortioxetine
Tablet 5mg, 10mg, 20mg
DTC Feb 2016
Not first-line treatment
Not first-line treatment
Not first-line treatment
Not first-line treatment
 BNF: “less suitable for prescribing”
 BNF: “less suitable for prescribing”
 BNF: “less suitable for prescribing”
Not first-line treatment
Prescribing
restrictions
Additional information
1st line antidepressant
1st line antidepressant
For use on “National
OCD service
recommendation” only
Not first-line treatment
Not first-line treatment
MR = modified release, used only where
the patient chooses
*Not first-line treatment
Restricted to major depressive episodes
in adults whose condition has responded
inadequately to two antidepressants
within the current episode.
See NICE TA367
* If clinically indicated or another preparation if the patient insists.
4.4 Central Nervous System Stimulants and other Medicines used for attention deficit hyperactivity disorder See TWC21s
Atomoxetine
capsule 10mg, 18mg, 25mg, 40mg,
Specialist ADHD
*Third line, after methylphenidate and
60mg
prescriber initiation only. dexamfetamine (unless there are anxiety
issues or risk of diversion)
See NICE TA98 Methylphenidate,
atomoxetine and dexamfetamine for
ADHD in children and adolescents
Dexamfetamine sulphate
tablet 5mg
Controlled Drug
See NICE TA98
Lisdexamfetamine
capsules 30mg, 50mg, 70mg
Controlled Drug, 2nd line
Methylphenidate
tablet 5mg, 10mg
Controlled Drug
hydrochloride
See NICE TA98
Methylphenidate
Xenidate, Concerta 27mg (only),
Controlled Drug
hydrochloride
Equasym , Medikinet XL
*1st line preparation, Xenidate
See NICE TA98
4.8 Antiepileptics (treatment / prevention of psychiatric symptoms)
Carbamazepine
tablet 100mg, 200mg, 400mg
Licensed for “prophylaxis of bipolar
tablet MR 200mg, 400mg
disorder not responsive to lithium.”
liquid 100mg / 5ml
Recommended in NICE Bipolar guideline
Clonazepam
tablet 500microgram, 2mg
Use other than for epilepsy is an
unlicensed indication
Lamotrigine
tablet 25mg, 50mg, 100mg, 200mg
Use other than for epilepsy is an
dispers. tab. 5mg, 25mg, 100mg
unlicensed indication
Recommended in NICE bipolar guideline
Midazolam
Buccolam 2.5mg, 5mg, 7.5mg and
Available for conscious sedation
10 mg oromucosal solution
according to Trust guidelines
Pregabalin
Capsules 25mg, 100mg, 300mg
3rd line as per NICE for GAD, initiation form to be completed.
Sodium valproate
tablet 100mg, 200mg, 500mg
1st line valproate
Endorse with ‘Epilim’ to avoid errors.
tablet MR 200mg, 300mg, 500mg
preparation
Should not be used during pregnancy and
liquid 200mg / 5ml
in women of child-bearing potential
unless clearly necessary i.e. in situations
where other treatments are ineffective or
not tolerated
DTC Feb 2016
* If clinically indicated or another preparation if the patient insists.
4.9 Medicines used in parkinsonism and related disorders
4.9.2 Antimuscarinic Medicines used in parkinsonism
Medicine
Formulations
tablet 5mg
liquid 5mg / 5ml
injection 5mg / 1ml
Trihexyphenidyl (Benzhexol) tablet 2mg, 5mg
4.10 Medicines used in substance dependence
Alcohol dependence
Acamprosate
tablet 333mg
Prescribing
restrictions
Additional information
Procyclidine
Disulfiram
tablet 200mg
Naltrexone
tablet 50mg
Nalmefene
tablet 18mg
Opioid dependence
Buprenorphine
DTC Feb 2016
tablet sublingual 8mg, 2mg &
400microgram
See blue book & Trust policy
Initiation by Addictions
teams only
Initiation by Addictions
teams only
Initiation by Addictions
teams only
May be initiated by GPs
only.
Patient must be engaged with a form of
psychosocial support provided by
Community Alcohol team or similar to
initiate this medicine.
See NICE TA115: Naltrexone for the
management of opioid dependence
See NICE TA325: Nalmefene for
reducing alcohol consumption in people
with alcohol dependence
Initiation by Addictions
teams only
Ensure opiate detox brand is used (i.e.not
Temgesic analgesic)
Controlled Drug
See NICE TA114 Methadone and
buprenorphine for the management of
opiod dependence
* If clinically indicated or another preparation if the patient insists.
Buprenorphine/naloxone
tablets
2mg/500microrams
8mg/2mg
Initiation by Addictions
teams only
Lofexidine
tablet 200micrograms
Initiation by Addictions
teams only
Methadone
Methadone
liquid “mixture” 1mg /1ml (sugar
free)
Tablet 5mg
Naltrexone
tablet 50mg
DTC Feb 2016
Substitution treatment for
opiod dependence in the
framework of medical
psychological and social
treatment for patients over
15yrs who have agreed to
treatment.
Addictions teams only
Initiation by Addictions
teams only
* If clinically indicated or another preparation if the patient insists.
 Those with a history crushing and
injecting tablets
 Known to divert prescribed medication
 Unable to comply with supervised
consumption of buprenorphine in first 3
months of treatment due to work or
child care commitments or physical
disability
 Transferred from another service
already initiated on Suboxone®.
 Controlled Drug
Controlled Drug
See NICE TA114
Controlled drug, as an option for
overseas travel where large volumes of
methadone liquid would be impractical
See NICE TA114
See TA115 Naltrexone for the
management of opioid dependence
Medicine
Formulations
Prescribing
restrictions
4.11 Medicines for dementia
Donepezil
tablet 5mg, 10mg
orodisp tablet 5mg, 10mg
Older peoples & LD
teams only
Galantamine
tablet 4mg, 12mg
Older peoples & LD
teams only
Older peoples & LD
teams only
Rivastigmine
capsule 1.5mg
liquid 2mg / 1ml
patch 4.6mg/24hours & 9.5mg /24
hours
Memantine
Tablet 10mg, 20mg
Liquid 5mg/pump
9.6.7 Multivitamin preparations
Sanatogen Gold
tablet
1.3.2 Selective antimuscarinics
Pirenzapine
tablet 50mg
See TWC21q shared care for
antidementia medicines
1st Line
See NICE TA217 Donepezil,
galantamine, rivastigmine and
memantine for the treatment of
Alzheimers disease
See NICE TA217
See NICE TA217
Older peoples & LD
teams only
See NICE TA217
Eating disorders
inpatient service only
For use alongside an emergency diet in
patients at risk of re-feeding syndrome
Antipsychotic induced
sialorrhoea, 2nd line
See Trust ‘off-label’ list appendix 1 of
TWC21k.
Imported from within the EU.
See Trust ‘off-label’ list appendix 1 of
TWC21h.
Hyoscine hydrobromide
tablet 500micrograms
Antipsychotic induced
sialorrhoea, 1st line
Atropine
1% eyedrops
Antipsychotic induced
sialorrhoea, used in
water or sublingually,
2nd line
DTC Feb 2016
Additional information
* If clinically indicated or another preparation if the patient insists.
See Trust ‘off-label’ list appendix 1 of
TWC21h.
Nutritional feeds used by the inpatient mental health service only:
Tube feeds:
Nutrison Standard 1.0 kcal/ml
Nutrison Energy 1.5k kcal/ml
Nutrison Multifibre 1.0 kcal/ml
Nutrison Energy Multifibre 1.5 kcal/ml.
Oral Nutrition Support products
Skandishake
Fortisip
Fortisip Multi Fibre
Fortisip Compact
Fortisip Compact Fibre
Fortimel
Fortisip Yoghurt Style
Fortisip Savoury Multi Fibre
Fortijuice
Calogen
Calogen Extra shot
Forticreme Complete
Fortisip Fruit Dessert
Complan Shake
Thickener/thickened products
Nutilis clear
Nutilis Complete
Complan
DTC Feb 2016
* If clinically indicated or another preparation if the patient insists.