TYPICAL DEPOT ANTIPSYCHOTICS

Transcription

1 Leicestershire Medicines Strategy Group Full SHARED CARE AGREEMENT FOR TYPICAL DEPOT ANTIPSYCHOTICS Prepared by: Zeibun Patel, Lead Pharmacist Prescribing Group, LPT Mr A Oxley, Head of Pharmacy, LPT On behalf of: NHS Leicester City NHS Leicestershire County and Rutland University Hospitals of Leicester NHS Trust Leicestershire Partnership Trust Date of preparation: June 2012 Revised: Date of next review: June 2014 Version: 1.0 Approved by the Leicestershire Medicines Strategy Group: July 2012 Page 1 of 5

2 Full Shared Care Policy for the prescribing of Typical Depot Antipsychotics Introduction and Purpose This shared care agreement has been produced following the recent production of the LMSG traffic light allocations that placed the majority of the atypical antipsychotics in the amber category. This comprises drugs that 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. Shared care has been defined as the mechanism of sharing patient care between primary and secondary care providers. This document sets out these responsibilities from initial diagnosis to on going support. This agreement should be read in conjunction with the Leicestershire Partnership NHS Trust CPA policy. Disease Background This shared care agreement covers all current licensed indications of the typical depot antipsychotics. For the latest licensed indications of individual drugs check the electronic medicines compendium at Drug covered by the agreement This agreement covers all typical depot antipsychotics included in the relevant section of the BNF that are classified as amber in the latest version of the LMSG traffic light classification. This can be reviewed at This currently includes Flupentixol decanoate, Fluphenazine decanoate, Haloperidol decanoate, Pipotiazine palmitate and Zuclopenthixol decanoate. Drugs are only covered by this agreement when prescribed at dosages within current BNF limits. Secondary Care Clinician Responsibilities Diagnosis based on a timely and comprehensive assessment, determining a management strategy and devising a CPA care plan in conjunction with the GP and support agencies/care manager. Ensuring that the baseline monitoring recommendations set down in the Trust Guidance on the monitoring of metabolic parameters in patients prescribed regular antipsychotics have been carried out before treatment initiation. This will usually be carried out in secondary care but in exceptional circumstances, and with the agreement of the GP, may be done in primary care. See table below for required monitoring. Personal & Family History Baseline Page 2 of 5

3 Fasting or random Lipid Profile (HDL and Triglycerides ) Relaying any abnormal findings from baseline assessment to the GP including advising the GP on the implications for future mental health medication prescribing. Initiation of prescription of any new typical depot antipsychotic under normal circumstances. Titration of the new typical depot antipsychotic dose to the optimum level using the optimum preparation for the individual patient. Prescription of one month s supply of the new medication (2 weeks if being discharged from in-patient care) after a stable dose has been achieved. Discussion of appropriate lifestyle issues e.g. healthy eating with the patient. Monitoring for response and adverse drug reactions (ADRs) during the titration period and whilst prescriptions are sourced through secondary care. Ensuring that the recommendations for monitoring three months after initiation set down in the Trust Guidance on the monitoring of metabolic parameters in patients prescribed regular antipsychotics are carried out. This will usually be carried out in secondary care but in exceptional circumstances, with the agreement of the GP, may be done in primary care. Fasting or random Lipid profile 15 (HDL and Triglycerides) 3 MONTHS after initiating or switching antipsychotics Liaison with the general practitioner (GP) to share the patient s care when a stable dose has been achieved and a long term choice of preparation has been made following the prescription of one month s supply. This must be done using the Shared Care Agreement Form. Outlining to GP when therapy may be reduced and stopped assuming no relapse in patient s condition. Evaluating ADRs raised by the GP and evaluating any concerns arising from physical checks by GP. Advising GP on related issues such as drug interactions etc. GP Responsibilities Page 3 of 5

4 Confirm or decline request to share patient s care as soon as possible, by faxing the shared care agreement form to the secondary care clinician. Carrying out the baseline monitoring requirements and monitoring four months after initiation as set down in the Trust agreement on monitoring of antipsychotics in exceptional circumstances, and after agreement of the GP, following request from secondary care. Prescription of typical depot antipsychotic after initial supply by secondary care clinician. Carrying out the annual monitoring recommendations set down in the Leicestershire Partnership NHS Trust Guidance on the monitoring of metabolic parameters in patients prescribed regular antipsychotics and feeding back clinically significant results to the secondary care clinician for advice on the impact on mental health medication. Fasting or random Lipid Profile 15 (HDL and Triglycerides) Annually 3 monthly for 1 year Observing patient for evidence of ADRs, and subsequent completion of yellow card, and raising this with secondary care clinician if necessary. Monitoring the patient s mental health status whilst taking prescribing responsibility, ensuring advice is sought from the secondary care clinician if there is any significant change. Reducing and stopping treatment in line with secondary care clinician s original request. Contact for support and advice Supervising Consultant Leicestershire partnership NHS Trust Further information Full prescribing information can be found in the SPCs available from the emc website at Flupentixol decanoate (Depixol, Depixol conc. and Depixol Low Volume, Lundbeck) Fluphenazine decanoate (Modecate, Modecate Concentrate, Sanofi-Aventis) Generic also available. Haloperidol deacanoate (Haldol Decanoate, Janssen) Pipotiazine palmitate (Piportil Depot, Sanofi-Aventis) Zuclopenthixol decanoate (Clopixol and Clopixol Conc., Lundbeck) Page 4 of 5

5 Additional Medicines Information is available from: Trent Medicines Information Centre Victoria Building. Leicester Royal Infirmary, LE1 5WW Tel: / Fax: Page 5 of 5