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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.01.02  Expand sub section  Anxiolytics
 note 
  • Limit to short period of time and review CSM Advice
  • Diazepam and its active metabolite have a long half life. There is a potential for accumulation especially in the very elderly.
  • Diazepam should only be given by the intramuscular route when oral and intravenous routes are not possible
  • Propranolol can often relieve the somatic symptoms of anxiety without the risks associated with benzodiazepine dependence
  • General Anxiety Disorder and Panic Disorder treatment options include antidepressant therapy
Diazepam
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First Choice
Green
 
Lorazepam
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Restricted Drug Restricted
Green
Lorazepam is shorter-acting than diazepam and seems more likely to produce dependence. For this reason it should only be prescribed as an anxiolytic for existing users or where treatment will be for a very short time (e.g. for its amnesic effect when a course of cytotoxic chemotherapy is administered). Lorazepam may occasionally be useful in calming an acutely agitated patient if used with an antipsychotic agent such as haloperidol.

 

Link  LPT Guidance: Rapid Tranquilisation Policy
Link  UHL Guidelines: Rapid Tranquilisation of Disturbed Adult Patients
   
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Key
note Notes
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Section Title Section Title (sub level)
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Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
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SMC
Scottish Medicines Consortium
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
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Homecare
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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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