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North East and North Cumbria
ICS Formulary |
| Formulary Chapter 4: Central nervous system - Full Chapter
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| Chapter Links... |
 MHRA Drug Safety Alert (Feb 2015): Drugs and driving: blood concentration limits set for certain drugs |
 NENC Palliative and End of Life Care Symptom Control Guidelines |
| NICE NG62: Cerebral palsy in under 25s: assessment and management |
| TEWV - Medicines Optimisation – Interactive Guide |
| TEWV Guidelines |
| TEWV Safe Transfer of Prescribing Guidance |
| Details... |
| 04.02.03 |
Drugs used for mania and hypomania |
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Other anticonvulsant drugs are used in the management of bipolar disorders e.g. Lamotrigine for the depressive phase. Such use is ‘off-licence’. |
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Lamotrigine
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Formulary
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Olanzapine (oral)
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Formulary
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Quetiapine
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Formulary
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Risperidone (oral)
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Formulary
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MHRA Drug Safety Update (Nov 2013): Risperidone and paliperidone: risk of intraoperative floppy iris syndrome in patients undergoing cataract surgery
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| 04.02.03 |
Benzodiazepines |
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| 04.02.03 |
Antipsychotic drugs |
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| 04.02.03 |
Carbamazepine |
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Carbamazepine
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Formulary
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| 04.02.03 |
Valproic acid |
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Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP) |
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Sodium valproate 200mg, 300mg, and 500mg tablets (Epilim Chrono®)
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Formulary
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- Sodium valproate 200mg, 300mg, and 500mg (Epilim Chrono®) tablets are approved for the prevention and treatment of manic episodes associated with bipolar disorder (
 unlicensed indication). May be useful in patients unresponsive to lithium.
Valproate must no longer be prescribed to women and girls of childbearing potential unless there is no alternative and they are on the Pregnancy Prevention Programme (PPP) 
 Black Triangle in females
For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:
MHRA Drug Safety Updates (valproate)
Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): new safety and educational materials to support regulatory measures in men and women under 55 years of age (MHRA Drug Safety Update January 2024)
Valproate use in men: as a precaution, men and their partners should use effective contraception (MHRA Drug Safety Update September 2024)
Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): review by two specialists is required for initiating valproate but not for male patients already taking valproate. (MHRA Drug Safety Update February 2025)
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Valproate medicines: Pregnancy Prevention Programme materials
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Valproic Acid (Depakote®)
(Semisodium valproate)
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Formulary
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- Licensed alternative to sodium valproate MR tablets.
Valproate must no longer be prescribed to women and girls of childbearing potential unless there is no alternative and they are on the Pregnancy Prevention Programme (PPP)
▼Black Triangle in females
For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:
MHRA Drug Safety Updates (valproate)
Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): new safety and educational materials to support regulatory measures in men and women under 55 years of age (MHRA Drug Safety Update January 2024)
Valproate use in men: as a precaution, men and their partners should use effective contraception (MHRA Drug Safety Update September 2024)
Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival, and Syonell▼): review by two specialists is required for initiating valproate but not for male patients already taking valproate. (MHRA Drug Safety Update February 2025)
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Valproate medicines: Pregnancy Prevention Programme materials
Local Shared Care guideline in TEWV to support Valproate Pregnancy Prevention Programme
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| 04.02.03 |
Lithium |
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Lithium Carbonate
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Formulary
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 NENC Shared Care Protocol - Lithium for adult patients within mental health services
TEWV Safety guidance: Lithium on admission to an acute hospital ward
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Lithium Citrate
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Formulary
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NENC Shared Care Protocol - Lithium for adult patients within mental health services
TEWV Safety guidance: Lithium on admission to an acute hospital ward
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. These medicines are considered suitable for primary care prescribing following specialist initiation of therapy and stabilisation, with ongoing communication between the primary care prescriber and specialist as set out in the associated shared care guideline (SCG). Shared care should be initiated by the specialist, which includes consultant, suitably trained specialist non-medical prescriber or GPwER within a secondary, tertiary, or primary care clinic.
The specialist should send the primary care prescriber a copy of the NENC Clinical Effectiveness and Governance (CEG) Subcommittee approved SCG to sign. The primary care prescriber should sign the SCG or indicate reasons why they are unable to accept the agreement and return a copy back to the specialist, as soon as possible.
SCGs are available or are being developed for most of the drugs listed as AMBER. |
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Drugs normally recommended or initiated by a hospital specialist who is a prescriber, a GP with an extended role [GPwER], or a specialist within primary care which can be safely maintained in primary care and monitored in primary care. In some cases, a further restriction for use may be defined. The primary care prescriber must be familiar with the drug to take on prescribing responsibility or must obtain the required information from the specialist. Therefore, provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by primary care prescriber or provide information re stopping criteria.
These are considered suitable for primary care prescribing following specialist assessment and recommendation of therapy, with ongoing communication between the primary care prescriber and specialist, if necessary.
In some case these drugs require specialist initiation and short to medium term monitoring of efficacy or toxicity until the patient’s dose is stable. Following specialist review the patient may be transferred to primary care for ongoing prescribing. Ongoing prescribing by primary care can include, if required, additional dose titrations and assessment of efficacy, with ongoing communication between the primary care prescriber and specialist, if necessary.
If the drug requires urgent initiation, it is expected that the specialist undertakes the initial prescribing responsibility for an appropriate period of time, usually a minimum of 28 days. A GREEN+ drug can only be recommended to primary care for initiation if does not need to be initiated within 28 days. |
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Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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Drugs that have been considered by the NENC Clinical Effectiveness and Governance (CEG) Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria ICS. These may also include all medicines with a “not NHS” or “DLCV” classification in the BNF, those agents as included within the NICE “Do not do” list, and those agents included with the NHS England: Items which should not routinely be prescribed in primary care. |
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