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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.01.01  Expand sub section  Hypnotics
 note 
  • Consider non pharmacological treatments first e.g. sleep hygiene (Principles of sleep hygiene below, Leicestershire Partnership patient leaflet available here)
  • Prescribe a hypnotic only if severe insomnia is interfering with normal daily life
  • Limit to short period of time and review BNF advice.
  • If treatment with one of the recommended hypnotic medicines does not work, the doctor should not prescribe one of the others available.

Principles of sleep hygiene

  • Avoid excessive use of caffeine, alcohol or nicotine. A hot milky drink at bedtime may help promote sleep.
  • Do not stay in bed if not asleep.
  • Avoid daytime naps or periods of inactivity.
  • A warm bath or exercise a few hours before bedtime may promote sleep.
  • Avoid strenuous physical or mental activity near to bedtime.
  • Make sure the bed and bedroom are comfortable; avoid extremes of noise and temperature.
  • Rise at the same time every morning, regardless of sleep duration.

In patient use: recommendations

  • All PRN hypnotic prescriptions should be endorsed with a maximum frequency of 5 nights out of 7
  • PRN hypnotics should not be offered before 11pm
  • All regular hypnotic prescriptions should be assigned a review date of 2 weeks to ensure usage does not become long-term
  • All prescriptions for hypnotics on discharge should be queried unless the patient was a regular user of hypnotics prior to admission

04.01.01  Expand sub section  Pitolisant
Pitolisant (Wakix®)
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber Simple

For treatment of narcolepsy.

Restricted to initiation by Specialist at Sleep Clinic.

 
   
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Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Black

Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety. All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry   

Red

Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).  

Amber SCA

Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.   

Amber Simple

Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.  

Green Conditional

Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence see comments under individual entries.   

Green

Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.   

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