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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.02  Expand sub section  Drugs used in psychoses and related disorders
 note 
  • For new onset psychosis seek specialist psychiatric advice
  • If the therapeutic goal is calming then a benzodiazepine may be more appropriate. These should only be prescribed for short periods.
  • If there is an ongoing requirement for antipsychotics seek specialist advice.
  • ECG monitoring is required before initiation of many antipsychotic drugs. Check SPC before prescribing
  • Patients on atypical antipsychotics should be monitored in line with the Leicestershire Partnership Trust Guidance on the monitoring of metabolic parameters in patients prescribed regular antipsychotics and agreed shared care agreement for prescribing of atypical antipsychotics. 
  • The Royal College of Psychiatrists has issued advice on the use of antipsychotics above their licensed dose.  Leicestershire Partnership Trust (LPT) guidance available below.
  • There is a clear increased risk of stroke and a small increased risk of death when antipsychotics (typical or atypical) are used in elderly people with dementia. Local guidance on management of behavioural problems in dementia and an antipsychotic drug prescribing care plan in dementia have been produced. 
  • Levomepromazine is also used in the treatment of nausea and vomiting associated with cytotoxic therapy.
  • Zuclopenthixol acetate (Clopixol Acuphase) is available for use only by specialists in psychiatric settings.
  • Haloperidol may be used by specialists in palliative care or ITU.  It is also an option for use in rapid tranquilisation if a parenteral form is required and appropriate.
Risperidone
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First Choice
Amber SCA
 
Amisulpride
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Restricted Drug Restricted
Amber SCA

For use on the advice of a specialist in psychiatry. 

Link  SCA: Atypical Antipsychotics
   
Clozapine
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Red
For use on the advice of a specialist in psychiatry.
Treatment resistant schizophrenia. Classified RED i.e. not suitable for GP prescribing



 
   
Flupentixol
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
For use on the advice of a specialist in psychiatry for schizophrenia 
Link  SCA: Typical Antipsychotics
   
Lurasidone
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
Schizophrenia in adults aged 18 years and over.
For those who do not respond to or do not tolerate aripiprazole, or those who are not suitable for clozapine. 
   
Olanzapine
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA

For use on the advice of a specialist in psychiatry. Also licensed for treatment of mania.

Long-term safety and tolerability of olanzapine:
Following long-term (>24 weeks) treatment with olanzapine, the types of metabolic changes seen in young people aged 12−18 years are similar to those seen in adults. However, the magnitude of changes in parameters such as body weight and some blood lipid levels appears to be greater in young people
 

Link  SCA: Atypical Antipsychotics
   
Promazine Hydrochloride
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Green
Short term adjunctive management of psychomotor agitation
Option for the treatment of agitation in the elderly but see also guidance on treatment of behavioural disturbance in dementia below. 
Link  Antipsychotic care plan for behavioural problems in patients with dementia
Link  Managing behavioural problems in patients with dementia
   
Quetiapine
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
Immediate release tablets only. For use on the advice of a specialist in psychiatry in line with NICE Clinical Guideline for Bipolar Disorder only. 
Link  NICE CG 185: Bipolar Disorder
Link  SCA: Atypical Antipsychotics
   
Sulpiride
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Green Conditional
If for use in schizophrenia or psychoses–to be initiated after discussion with specialist 
   
Zuclopenthixol
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
For use on the advice of a specialist in psychiatry 
Link  SCA: Typical Antipsychotics
   
Aripiprazole Oral
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
For bipolar disorder restricted to use in line with NICE TA
In Schizophrenia as an option if quetiapine causes problems with prolactin, aripiprazole is the drug of choice in these circumstances.

Date of entry of decision to Formulary:July 2013

 
Link  NICE TA 292: Aripiprazole in Bipolar Disorder (adolescents)
Link  SCA: Atypical Antipsychotics
   
Aripiprazole I.M.
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Red
Intramuscular preparation available for Rapid Tranquilisation only.
 
Link  Leicestershire Partnership (LPT) Guidance: Quick Reference Guide; Rapid Tranquilisation
Link  Leicestershire Partnership Trust (LPT) Guidance: Aripiprazole
Link  LPT Guidance: Rapid Tranquilisation, full policy
   
04.02.02  Expand sub section  Antipsychotic depot injections
Aripiprazole long-acting injection (Abilify Maintena®)
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
Specialist in Psychiatry Initiation only 
Link  SCA: Atypical Antipsychotics
   
Flupentixol Decanoate
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
Specialist in Psychiatry Initiation only 
Link  SCA: Typical Antipsychotics
   
Fluphenazine Decanoate
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
Specialist in Psychiatry Initiation only 
Link  SCA: Typical Antipsychotics
   
Haloperidol Decanoate
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
Specialist in Psychiatry Initiation only 
Link  SCA: Typical Antipsychotics
   
Risperidone (Risperdal Consta®)
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
Specialist in Psychiatry Initiation only. 
Link  Leicestershire Guidance: Risperdal Consta
Link  SCA: Atypical Antipsychotics
   
Zuclopenthixol Decanoate
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
Specialist in Psychiatry Initiation only. 
Link  SCA: Typical Antipsychotics
   
Olanzapine embonate (olanzapine pamoate) (Zypadhera®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red
For use by specialists in psychiatry only  
   
04.02.03  Expand sub section  Drugs used for mania and hypomania
 note  Olanzapine is also licensed for treatment of mania
Carbamazepine
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted Specialist in Psychiatry Initiation only. 
Link  Leicestershire Guidance: Antiepileptics and Bone Mineral Density
Link  Toxicology and Therapeutic Dose Monitoring
   
Lithium
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber SCA
Specialist in Psychiatry Initiation only. BNF recommends to prescribe by brand. Priadel is the brand recommended for new patients due to cost. 
Link  Leicestershire Guidelines: Lithium in Acute and Primary Care Settings
Link  NPSA alert: Safer Lithium Therapy
Link  SCA: Lithium
Link  Toxicology and Therapeutic Dose Monitoring
   
Semisodium Valproate (Depakote®)
View adult BNF View SPC online  Track Changes
Restricted Drug Restricted
Amber Simple
Mania in bipolar disorder. Specialist in Psychiatry Initiation only. 
Link  Drug Safety Update: Valproate medicines (Epilim▼, Depakote▼)
Link  MHRA Guidance: Valproate use by women and girls
Link  Resources to Use: Booklet for Healthcare Professionals
Link  Resources to Use: Card to give to patients
Link  Resources to Use: Consultation Checklist
Link  Resources to Use: Guide to give to patients
Link  Topiramate and Valproate Flow Chart
   
 ....
 Non Formulary Items
Brexpiprazole

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black

LPT prescribing group have reviewed and found no significant advantages over existing formulary products

 
Cariprazine

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Black
 
Erenumab  (Aimovig®)

View adult BNF View SPC online Track Changes
Non Formulary
Black

Awaiting NICE TA publication

 
Fremanezumab  (Ajovy®)

View adult BNF View SPC online Track Changes
Non Formulary
Black

Awaiting NICE TA publication

 
Galcanezumab  (Emgality®)

View adult BNF View SPC online Track Changes
Non Formulary
Black

Awaiting NICE TA publication

 
Quetiapine modified release (XL)

View adult BNF View SPC online Track Changes
Non Formulary
Link  SCA: Atypical Antipsychotics
 
Trifluoperazine

View adult BNF View SPC online Track Changes
Non Formulary
 
  
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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