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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.02.01  Expand sub section  Antipsychotic Drugs
 note 
  • All antipsychotics should be employed at the minimum effective doses possible, higher doses will increase the likelihood of side effects. An alternative antipsychotic should be considered rather than resorting to the use of higher than standard doses
  • For new onset psychosis seek specialist psychiatric advice.
  • Atypical and typical antipsychotics should not be prescribed concurrently except when switching from one to another  
  • For the treatment of antipsychotic induced extra-pyramidal side effects, refer to Section 4.9.2 
  • Oro-dispersible tablets and oral solutions are more expensive therefore reserved for poorly compliant patients or those with swallowing difficulties.
  • Antipsychotics should not routinely be prescribed to elderly patients with dementia to treat mild to moderate psychotic symptoms, because they are associated with a small increased risk of mortality and increased risk of stroke or transient ischaemic attack.
 
04.02.01  Expand sub section  First-Generation Antipsychotic Drugs
04.02.01  Expand sub section  Second-Generation Antipsychotic Drugs
Amisulpride
(Tablet, oral solution)
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Restricted Drug Restricted
Amber No SCG

  • Requires specialist initiation by mental health team

 
   
Aripiprazole
(Tablets, orodispersible tablets, short acting injection, liquid)
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Restricted Drug Restricted
Amber No SCG

  • Requires specialist initiation by mental health team

 
Link  CPFT Guideline for the pharmacological management of acute behavioural disturbance in in-patient wards
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
Link  NICE TA292: Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder
   
Clozapine (Denzapine®, Clozaril®, Zaponex®)
(Tablet, oral suspension)
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Restricted Drug Restricted
Red Hospital

  • Initiation by consultant psychiatrist only.

  • Patients should receive the brand specific to the monitoring service with which they are registered.

  • CPFT brand of choice is DENZAPINE®

  • All patients must be registered with the Fulbourn Pharmacy or the Cavell Centre Pharmacy.

  • WARNING: Missed doses are particularly significant in someone taking Clozapine. Please contact your local CPFT pharmacy department (including the out of hours service if applicable) and the patient’s psychiatrist if you are aware of a patient that has missed doses of Clozapine.


 


 


 

 
Link  CPFT clozapine information webpage
Link  CPFT Clozapine Initiation and Prescribing Guidelines
Link  Drug-induced hypersalivation – what treatment options are available? (UKMI Q&A)
Link  MHRA Drug Safety Update October 2017: Clozapine - impairment of intestinal peristalsis
   
Olanzapine
(Tablet, Orodispersible tablet)
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Restricted Drug Restricted
Amber No SCG

 



  • For mental health conditions - requires specialist initiation by mental health team

  • CUHFT: use in line with Trust guidelines on delirium and dementia in older patients.

  • RPH: For management of delirium in critical care.

  • NWAFT: Restricted to use in palliative care
     


NeLM in-Focus review: metabolic adverse effects with atypical antipsychotics. Bottom line: Emerging data suggest that the risks of adverse metabolic effects, including hyperglycaemia, diabetes, weight gain and dyslipidaemia, are greater with olanzapine than other atypical antipsychotics (with the exception of clozapine).


 


 

 
Link  CPFT Guideline for the pharmacological management of acute behavioural disturbance in in-patient wards
   
Quetiapine
(Immediate release (IR) tablet, modified release (MR) tablet, oral suspension)
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Restricted Drug Restricted
Amber No SCG

  • For mental health conditions - requires specialist initiation by mental health team

  • Immediate release (IR) tablets should be prescribed where possible

  • Modified release tablets are significantly more expensive and are restricted to where a patient experiences excessive sedation and/or hypotension on quetiapine IR,  OR if patient compliance is improved compared to twice daily dosing with quetiapine IR.

  • If a patient is discharged on a modified release preparation then the rationale for this should be communicated to the GP. NB Only the modified release tablets are licensed for the adjunctive treatment of major depression

  • In primary care Biquelle® XL is the preferred choices of quetiapine XL if clinically required.

  • CUHFT: Neurologist/DME consultants for management of drug induced psychoses in Parkinson's Disease patients (off-label).

  • NWAFT: Restricted to use in palliative care

  • RPH: Restricted to the management of delirium when haloperidol is contra-indicated

 
Link  CPJPG Recommendations for Quetiapine XL
Link  NICE Evidence summary ESUOM12 : Quetiapine for generalised anxiety disorder
   
Risperidone
(Tablet, orodispersible tablet, oral solution)
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Restricted Drug Restricted
Amber No SCG

  • For mental health conditions - Requires specialist initiation by mental health team, with the exception of low dose risperidone which can be initiated in primary care

  • CUHFT: Restricted to use in line with Trust guidelines on delirium and dementia in older patients

  • NWAFT: Restricted to use in palliative care

  • RPH: Restricted to the continuation of treatment initiated external to the Trust

  • Doses above 8-10mg daily may not increase therapeutic benefit but may result in extrapyramidal side effects.


 

 
Link  CPFT Guideline for the pharmacological management of acute behavioural disturbance in in-patient wards
Link  CUHFT: Prevention, diagnosis and management of delirium and dementia in older patients
   
Lurasidone (Latuda®)
(Tablet)
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Restricted Drug Restricted
Red Hospital

  • CPFT: Formulary

  • Non-formulary at all other Trusts and in Primary Care


 

 
Link  NICE Evidence summary ESNM48: Schizophrenia - Lurasidone
   
Olanzapine
(Injection)
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Restricted Drug Restricted
Red Hospital

  • CPFT: unlicensed unlicensed Short acting IM injection available for rapid tranquillisation.

  • Olanzapine IM injection must not be given within 1 hour of any parenteral benzodiazepine (including lorazepam IM injection and midazolam IM injection)

  • Non-formulary at all other Trusts and in Primary Care

 
Link  CPFT Guideline for the pharmacological management of acute behavioural disturbance in in-patient wards
   
 ....
 Non Formulary Items
Cariprazine  (Reagila®)
(Capsule)

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Non Formulary
Grey
 
Clozapine  (Zaponex®)
(Tablet)

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Non Formulary
Non Formulary

  • Initiation by consultant psychiatrist only.

  • Patients should receive the brand specific to the monitoring service with which they are registered.

 
Paliperidone
(MR tablets)

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Non Formulary
Non Formulary

  • MR tablets are non-formulary

Link  MHRA: Risk of intraoperative floppy iris syndrome in people undergoing cataract surgery (Oct 13)
 
  
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
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
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

OTC

Available Over the Counter. Consider Self Care   

Green

Formulary - Can be prescribed in both secondary and primary care.   

Advice

Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

Amber No SCG

Formulary - Specialist initiation without shared care guidance.  

Amber SCG

Formulary - Specialist initiation with shared care guidance.  

Red Hospital

Restricted - Hospital only, not to be prescribed in primary care.  

Switch

Not recommended for prescribing. Switch to alternative cost-effective option.   

Black

Not recommended for prescribing in primary or secondary care.  

Grey

Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

Non Formulary

Non-Formulary (category under review).  

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