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 Formulary Chapter 4: Central nervous system - Full Chapter
04.02.01  Expand sub section  Antipsychotic Drugs
04.02.01  Expand sub section  First-Generation Antipsychotic Drugs
04.02.01  Expand sub section  Second-Generation Antipsychotic Drugs
 note 

APC advice (March 2010)
The balance of risks and benefit should be considered before prescribing antipsychotics drugs for elderly patients. In elderly patients with dementia antipsychotic drugs are associated with a small increased risk of mortality and an increased risk of stroke or transient ischaemic attack.

  • Risperidone is licensed for short-term treatment (up to 6 weeks) of persistent aggression in patients with moderate to severe Alzheimer’s dementia unresponsive to non-pharmacological interventions and when there is a risk of harm to self or others. Therefore it is recommended as 1st line therapy in these circumstances
Amisulpride 
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Formulary
Amber

Amisulpride Tablet 50mg 
Amisulpride Tablet 100mg 
Amisulpride Tablet 200mg 
Amisulpride Tablet 400mg 
Amisulpride Oral Solution 100mg/ml SF

 
   
Aripiprazole 
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Formulary
Amber

FIRST CHOICE
Aripiprazole Tablet 5mg 
Aripiprazole Tablet 10mg 
Aripiprazole Tablet 15mg 
Aripiprazole Tablet 30mg 

SECOND CHOICE 
Aripiprazole Orodispersible Tablet 10mg S/F 
Aripiprazole Orodispersible Tablet 15mg S/F

THIRD CHOICE 
Aripiprazole Oral Solution 5mg/5ml- Use liquid only in patients with swallowing difficulties due to higher costs (Applicable in Primary care only)

Prescribe generically.

 
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 (Clozaril)
(Prescribe by brand)
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Formulary
Red

Clozapine Tablet 25mg
Clozapine Tablet 50mg
Clozapine Tablet 100mg 
Clozapine Tablet 200mg

Restriction: Initiation by psychiatrist registered with Clozapine monitoring service

Patient, prescriber and supplying pharmacist must be registered with the Patient Monitoring Service. Treatment is only continued if there are acceptable leucocyte and neutrophil counts.

Brands include Clozaril, Denzapine or Zaponex.

MHRA/CHM advice: Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus (October 2017)

 
   
Olanzapine 
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Formulary
Amber

Olanzapine Tablet 2.5mg 
Olanzapine Tablet 5mg 
Olanzapine Tablet 7.5mg
Olanzapine Tablet 10mg 
Olanzapine Tablet 15mg 
Olanzapine Tablet 20mg 
Olanzapine Orodispersible Tablet 5mg 
Olanzapine Orodispersible Tablet 10mg 
Olanzapine Orodispersible Tablet 15mg

Do not prescribe Oral Lyophilisates preparations -  Very Expensive-(Applicable in Primary care only)

 
   
Quetiapine 
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Formulary
Amber

FIRST CHOICE- normal release tablets
Quetiapine Tablet 25mg 
Quetiapine Tablet 100mg 
Quetiapine Tablet 150mg 
Quetiapine Tablet 200mg 
Quetiapine Tablet 300mg 

SECOND CHOICE - MR where there are compliance issues
Sondate XL Tablet 50mg 
Sondate XL tablet 150mg 
Sondate XL Tablet 200mg 
Sondate XL Tablet 300mg 
Sondate XL Tablet 400mg

THIRD CHOICE - If Sondate XL is unavailable
Biquelle XL Tablet 50mg 
Biquelle XL tablet 150mg 
Biquelle XL Tablet 200mg 
Biquelle XL Tablet 300mg 
Biquelle XL Tablet 400mg

Prescribers should choose the most cost-effective option (Applicable in Primary care only)

 

 
   
Risperidone 
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Formulary
Amber

Risperidone Tablet 500mcg
Risperidone Tablet 1mg 
Risperidone Tablet 2mg 
Risperidone Tablet 3mg 
Risperidone Tablet 4mg 
Risperidone Orodispersible Tablet 500mcg SF 
Risperidone Orodispersible Tablet 1mg SF 
Risperidone Orodispersible Tablet 2mg SF 
Risperidone Orodispersible Tablet 3mg SF 
Risperidone Orodispersible Tablet 4mg SF 
Risperidone Oral Solution 1mg/ml SF

Prescribe generically

See APC advice above (March 2010)

 
   
Levomepromazine (Methotrimipramine)
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Formulary
Green

Levomepromazine Tablets 25mg
Levomepromazine solution for injection ampoules 25mg/ml


Restriction: For use in Palliative Care

 
   
 ....
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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

Medicines that can only be prescribed within Secondary Care. Examples of medicines which fall into this category are: Certain new medicines and new indications for older medicines where there is at present no experience of use in Primary Care. Medicines or dressings not available or prescribable in Primary Care. Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available   

Amber

Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral. There is no need for approved shared care guidelines for medicines in this category. This replaces Amber 2 on the North Staffs Formulary.   

Amber E

Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD). This replaces Amber 1 on the North Staffs Formulary  

Green

Medicines which can be prescribed in either Primary or Secondary Care.  

Grey

These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary. Inadequate or weak evidence for efficacy No clearly defined local need Lack of long term safety data No perceived benefit over established formulary alternatives Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or not tolerated.  

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