Formulary for mental health medications
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1 Formulary for mental health medications The Medicines Management Committee has approved this list of formulary medicines with links to national and local prescribing guidelines. If a medicine for a mental health condition (or the treatment of substance misuse) is not on this list then it is not on the Trust Formulary; pharmacy should be contacted for advice. The full formulary process is described in the CPFT Medicines Policy. Specific comments are included for medicines that are covered by: NICE Technology Appraisals CPFT prescribing guidelines CSM (Committee for Safety of Medicines) or MHRA (Medicines and Healthcare Regulatory Agency) advice in the BNF CCG prescribing restrictions The following NICE clinical guidelines contain recommendations about drug treatment of mental health conditions ( Schizophrenia in adults (CG82) March 2009 Bipolar disorder in adults, children and adolescents (CG38) July 2006 Rapid tranquillisation: disturbed/violent behaviour in psychiatric in-patient settings and emergency departments (CG25) Feb 2005 Depression in adults (CG90) and in adults with a chronic physical health problem (CG91) Oct 2009 Depression in children and young people (CG28) Sept 2005 Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults (CG113) Jan 2011 ADHD in children, young people and adults (CG72) Sept 2008 Dementia (CG42) March 2011 Opioid detoxification (CG52) July 2007 Alcohol-related physical complications (CG100) June 2010 Harmful drinking and alcohol dependence (CG115) Feb 2011 Antisocial personality disorder (CG77) Jan 2009 Borderline personality disorder (CG78) Jan 2009 Antenatal and postnatal mental health (CG45) April 2007 Obsessive-compulsive disorder and body dysmorphic disorder (CG31) Nov 2005 PTSD in adults and children (CG26) April 2005 Eating disorders (CG9) April 2004 Smoking cessation services (PH10) Aug 2008 Autism in adults (CG142) June 2012 Psychosis and schizophrenia in children and young people Jan
2 Medicine (alphabetical order within BNF sections) Hypnotics BNF Cloral betaine Melatonin (Children s services only) Comments NICE TA77: z drugs in the short-term management of insomnia CPFT D&T minutes of CSM advice in the BNF about the prescribing of benzodiazepines. Third-line Off-label use of a licensed medicine; or unlicensed medicine* Nitrazepam Third-line Promethazine Temazepam First-line Zopiclone If temazepam is not considered suitable Anxiolytics mostly BNF CSM advice in the BNF about the prescribing of benzodiazepines CPFT Rapid tranquillisation guidelines Buspirone Clonazepam (BNF 4.8.2) Off-label use of a licensed medicine * Diazepam Lorazepam Midazolam (BNF ) Oxazepam Pregabalin (BNF 4.8.1) Promethazine (BNF 4.1.1) Antipsychotics BNF First-generation antipsychotics Chlorpromazine Flupentixol Fluphenazine Haloperidol Levomepromazine Sulpiride Trifluoperazine Zuclopenthixol (including Acuphase) Second-generation antipsychotics Amisulpride Aripiprazole (including short-acting IM injection) Clozapine Olanzapine (including short-acting IM injection) Quetiapine Alternative for rapid tranquillisation while IM lorazepam unavailable Only for second- or third-line use in GAD when SSRIs/venlafaxine not tolerated or not effective of a specialist Advice in the BNF about prescribing doses above BNF upper limit Advice in the BNF about prescribing antipsychotics in the elderly especially with dementia CPFT Rapid tranquillisation guidelines NICE TA213: Aripiprazole for the treatment of schizophreniain people aged years CSM advice in the BNF about the risk of myocarditis and cardiomyopathy with clozapine CPFT Clozapine prescribing guidelines Secondary Care (hospital) only prescribing 2
3 Risperidone Long-acting antipsychotic injections (depots) BNF Flupentixol decanoate Fluphenazine decanoate Haloperidol decanoate Paliperidone palmitate injection Paliperidone tablets are not on the formulary Paliperidone injection is available for GP prescribing after initiation by a specialist Pipotiazine palmitate Risperidone injection is available for GP prescribing after Risperidone long-acting injection initiation by a specialist Zuclopenthixol decanoate Antimanic drugs (also used as mood stabilisers) BNF Carbamazepine Lamotrigine (BNF 4.8.1) Licensed for prevention of depressive episodes associated with bipolar disorder Lithium CPFT Lithium prescribing guidelines Semisodium valproate (Depakote) Licensed only for treatment of manic episodes associated with bipolar disorder Sodium valproate (Epilim) (BNF 4.8.1) Off-label use of a licensed medicine * Antidepressants BNF 4.3 CSM advice in the BNF about antidepressants and the risk of suicidal thoughts and behaviour (esp in young people); also risk of hyponatraemia (esp in elderly) Tricyclic and related antidepressants BNF Amitriptyline Clomipramine Dosulepin Imipramine Lofepramine Nortriptyline Trazodone Monoamine oxidase inhibitors BNF Phenelzine Tranylcypromine Moclobemide (Reversible MAOI) Selective serotonin reuptake inhibitors BNF CSM advice in the BNF about the use of SSRIs in children and adolescents Citalopram Escitalopram Fluoxetine Paroxetine Sertraline Other antidepressants BNF Duloxetine Mirtazapine Tryptophan Not for first-line use of a specialist CSM advice in the BNF about appropriate doses of paroxetine. These are not an appropriate choice for the first-line treatment of depression of a specialist 3
4 Venlafaxine CNS stimulants and other drugs for attention deficit hyperactivity disorder BNF 4.4 Atomoxetine Dexamfetamine Methylphenidate Drugs used in substance dependence BNF 4.10 Alcohol dependence Acamprosate Chlordiazepoxide Disulfiram Nicotine dependence Nicotine replacement therapy Opioid dependence Buprenorphine (including buprenorphine plus naloxone) Lofexidine Methadone Naltrexone Drugs for dementia BNF 4.11 NICE TA98: Methylphenidate, atomoxetine and dexamfetamine for ADHD in children and adolescents Cambridgeshire Shared Care Guideline for the use of atomoxetine, methylphenidate and dexamfetamine in ADHD ( CPFT Alcohol detoxification guidelines All types of NRT are included NICE TA114: Methadone and buprenorphine for opioid dependence NICE TA115: Naltrexone for opioid dependence CPFT Opioid misuse guidelines NICE TA217: Donepezil, galantamine, rivastigmine and memantine for Alzheimer s disease Cambridgeshire Shared Care Guideline for the use of Alzheimer s drugs ( Donepezil Galantamine Memantine Rivastigmine Anticholinergic medication BNF Procyclidine Orphenadrine Trihexyphenidyl * It is accepted that other licensed medicines on this list may be used for off-label indications (see list of unlicensed uses of licensed medicines within the Medicines Policy). Non-formulary medicines Medicines that the Medicines Management Committee have classed as unsuitable for inclusion in the formulary should not usually be prescribed (or recommended to GPs for prescribing). These include: Zolpidem and zaleplon Reboxetine (removed from the formulary on safety grounds) Oral paliperidone Some newer medicines have not yet been considered for the formulary so should not usually be prescribed. These include: Olanzapine long-acting injection 4
5 Agomelatine Asenapine 5
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