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 Formulary Chapter 4: Central nervous system - Full Chapter
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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
Amisulpride 100mg/1mL
(solution)
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Restricted Drug Restricted
Amber Initiation

Restricted - only for use when patient cannot swallow ordinary tablets.


To be initiated by Consultant Psychiatrists and continued by GPs in accordance with the treatment of psychosis and schizophrenia algorithm (BHTCG 726FM)

 
   
Amisulpride 50mg, 200mg
(tablet)
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Restricted Drug Restricted
Amber Initiation

Restricted - To be initiated by Consultant Psychiatrists with continuation by GPs in accordance with the treatment of psychosis and schizophrenia algorithm (BHTCG 726FM)

 
   
Aripiprazole 10mg, 15mg
(orodispersible tablet)
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Restricted Drug Restricted
Amber Initiation

Initiation by Psychiatry team with continuation by GPs for treatment of;

1. Psychosis and schizophrenia in adults in accordance with Treatment of Psychosis and Schizophrenia algorithm (BHTCG 726FM).

2. Schizophrenia in people aged 15 to 17 years in accordance with NICE TA 213.

3. Up to 12 weeks for moderate to severe manic episodes in bipolar disorder in adolescents aged 13 to 18 years in accordance with NICE TA 292.

4. Augmentation in depression in accordance with Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressatns treatment algorithm (BHT 572FM). 


NOTE: Only for use when patient cannot swallow ordinary tablets.  NB an oral solution 1mg/ml is also available but should be reserved for patients with swallowing difficulties or to facilitate doses less than 5mg (smallest tablet size).

 
   
Aripiprazole 1mg/1mL
(oral solution)
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Restricted Drug Restricted
Amber Initiation

NOTE: Ony for patients with swallowing difficulties or to facilitate doses less than 5mg (smallest tablet size).

Initiation by Psychiatry team with continuation by GPs for treatment of;

1. Psychosis and schizophrenia in adults in accordance with Treatment of Psychosis and Schizophrenia algorithm (BHTCG 726FM).

2. Schizophrenia in people aged 15 to 17 years in accordance with NICE TA 213.

3. Up to 12 weeks for moderate to severe manic episodes in bipolar disorder in adolescents aged 13 to 18 years in accordance with NICE TA 292. 

4. Augmentation in depression - in accordance with  Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressants treatment algorithm (BHT 572FM). 

 
   
Aripiprazole 400mg
(powder and solvent for prolonged-release suspension for injection pre-filled syringe)
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Restricted Drug Restricted
Red
Restricted- prescribing by Consultant Psychiatrists only in accordance with Oxford Health Psychosis and Schizophrenia guideline.
 
Link  Oxford Health Psychosis and Schizophrenia guideline.
   
Aripiprazole 5mg, 10mg, 15mg, 30mg
(tablet)
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Restricted Drug Restricted
Amber Initiation

Initiation by Psychiatry team with continuation by GPs for treatment of;

1. Psychosis and schizophrenia in adults in accordance with Treatment of Psychosis and Schizophrenia algorithm (BHTCG 726FM).

2. Schizophrenia in people aged 15 to 17 years in accordance with NICE TA 213.

3. Up to 12 weeks for moderate to severe manic episodes in bipolar disorder in adolescents aged 13 to 18 years in accordance with NICE TA 292.

4. Augmentation in depression in accordance with Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressants treatment algorithm (BHT 572FM). 

NB an oral solution 1mg/ml is also available but should be reserved for patients with swallowing difficulties or to facilitate doses less than 5mg (smallest tablet size).

 
   
Aripiprazole 7.5mg/1mL (9.75mg/1.3mL vial)
(injection)
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Restricted Drug Restricted
Red
Restricted - prescribing by Psychiatric (Mental Health Trust) team only and for use in accordance with:

NICE TA213 - Aripiprazole for the treatment of schizophrenia in people aged 15 to 17 years (see link above) or,
NICE TA292 - Aripiprazole is recommended as an option for treating moderate to severe manic episodes in adolescents aged 13-18 years, with bipolar 1 disorder, within its marketing authorisation (ie. up to 12 weeks of treatment for moderate to severe manic episodes in bipolar disorder)(see link above)
 
   
Clozapine 25mg, 100mg
(tablet)
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Restricted Drug Restricted
Red

Restricted - prescribing by Consultant Psychiatrist (Mental Health Trust) only in accordance with the treatment of psychosis and schizophrenia algorithm (BHTCG 726FM).

 
Link  MHRA Drug Safety Update - October 17: Clozapine: Reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
   
Clozapine 50mg/1mL
(suspension)
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Restricted Drug Restricted
Red

Restricted - prescribing by Psychiatric (Mental Health Trust) team in accordance with the treatment of psychosis and schizophrenia algorithm (BHTCG 726FM).


Only for use when patient cannot swallow ordinary tablets.

 
Link  MHRA Drug Safety Update - October 17: Clozapine: Reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
   
Lurasidone Hydrochloride 18.5mg, 37mg, 74mg
(tablet)
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Restricted Drug Restricted
Red
Restricted - prescribing by Consultant Psychiatrists only for:
1. Patients with schizophrenia who cannot tolerate, or have contraindications to, commonly prescribed antipsychotics or aripiprazole.
2. Bipolar depression (OFF-LABEL use) . This needs to be approved by the Oxford Health team as per Oxford Health formulary requirements. 
   
Olanzapine 10mg/2mL
(vial)
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Restricted Drug Restricted
Red

unlicensedunlicensed
To be used in accordance with the Oxford Health Rapid transquilisation guideline (see above)

 
   
Olanzapine 2.5mg, 5mg, 7.5mg, 10mg, 20mg
(tablet)
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Restricted Drug Restricted
Amber Initiation

Initiation by Psychiatry team, continuation by GPs for:

1. Treatment of psychosis and schizophrenia algorithm (BHTCG 726FM).

2. Augmentation in depression in accordance with the Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressants treatment algorithm (BHT 572FM).

 
   
Olanzapine 5mg, 10mg, 15mg
(orodispersible tablet)
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Restricted Drug Restricted
Amber Initiation

Initiation by Psychiatry team, continuation by GPs for:

1. Treatment of psychosis and schizophrenia algorithm (BHTCG 726FM).

2. Augmentation in depression in accordance with the Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressants treatment algorithm (BHT 572FM).

Only for use when patient cannot swallow ordinary tablets.

 
   
Paliperidone 50mg, 75mg, 100mg, 150mg
(pre-filled syringe)
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Restricted Drug Restricted
Red
Restricted - prescribing by Mental Health Trust only, and recommended for patients discontinued from pipothiazine depot injection. 
   
Quetiapine 25mg, 100mg, 150mg, 200mg, 300mg
(tablet)
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Restricted Drug Restricted
Amber Initiation

Initiation by Psychiatry team, continuation by GPs for:

1. Treatment of psychosis and schizophrenia algorithm (BHTCG 726FM).

2. Augmentation in depression in accordance with the Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressants treatment algorithm (BHT 572FM). 

 
   
Quetiapine MR 50mg, 200mg, 300mg, 400mg
(tablet)
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Restricted Drug Restricted
Red

Restricted - prescribing by Consultant Psychiatrist (Mental Health Trust) only in accordance with the Treatment of Psychosis and Schizophrenia algorithm (BHTCG 726FM). Switch to immediate release tablets when maintenance level is reached.

 
   
Risperidone 1mg/1mL
(liquid)
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Restricted Drug Restricted
Amber Initiation

Initiation by Psychiatry team, continuation by GPs for:

1. Treatment of psychosis and schizophrenia algorithm (BHTCG 726FM).

2. Augmentation in depression in accordance with the Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressants treatment algorithm (BHT 572FM).

Only for use when patient cannot swallow ordinary tablets.

 
   
Risperidone 500micrograms, 1mg, 2mg
(orodispersibleTablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Initiation

Initiation by Psychiatry team, continuation by GPs for:

1. Treatment of psychosis and schizophrenia algorithm (BHTCG 726FM).

2. Augmentation in depression in accordance with Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressants treatment algorithm (BHT 572FM).

Only for use when patient cannot swallow ordinary tablets.

 
   
Risperidone 500micrograms, 1mg, 2mg, 3mg, 4mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Initiation

Initiation by Psychiatry team, continuation by GPs for:

1. Treatment of psychosis and schizophrenia algorithm (BHTCG 726FM).

2. Augmentation in depression in accordance with the Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressants treatment algorithm (BHT 572FM). 

 
   
Sertindole 4mg, 12mg, 16mg, 20mg
(film-coated tablets)
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Restricted Drug Restricted
Red
Restricted - prescribing by Oxford Health Consultant Psychiatrists as per Oxford Health formulary. 
   
 ....
 Non Formulary Items
Zotepine  (Zoleptil®)

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Non Formulary
 
  
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

Black

Not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.
Drugs which have been evaluated and rejected by the Medicines Value Group (MVG)
Drugs defined as ‘Low Priority’ by the South Central Priorities Committee
New drugs which have not as yet been evaluated by the MVG
Any drug not listed in the Buckinghamshire Formulary  

Red

Drugs which should only be prescribed in secondary care by a specialist.
Require specialist knowledge and/or equipment for patient selection and initiation
Require long term on-going monitoring and dose adjustment to ensure efficacy and minimise toxicity by a specialist
Designated as “hospital only“ by product licence, NICE, DoH or BNF
May need further evaluation by a specialist
Are hospital initiated clinical trial materials  

Red Specialist Centre

As for ‘red’ (above) with the addition of the following:
Designated by NHS England to require initiation by or in prior agreement with a Specialist Centre. Continuation where appropriate by BHT (or other secondary care provider)
Detailed requirements for Specialist Centre initiation to be described in the wording of the formulary restriction  

Amber Protocol

Drugs which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a drug specific Shared Care Protocol(SCP). Prescribing may be continued in primary care following the SCP
Require specialist knowledge and/or equipment for patient selection and initiation
Require short or medium term (eg. 3 to 6 months) specialist monitoring of efficacy or toxicity. The need for stabilisation will vary with different drugs and patients, but is usually a minimum of 2 months (see principles for shared care)
Require significant long term monitoring
Require ongoing communication between the GP and the specialist
Have clearly defined consultant, GP and patient responsibilities documented in a shared care protocol (see responsibilities for amber protocol drugs)  

Amber Initiation

Drugs suitable for primary care prescribing following specialist initiation
Require specialist knowledge and/or equipment for patient selection
Monitoring does not require specialist knowledge or equipment
If the drug is one with which the primary care prescriber is unfamiliar the specialist is expected to provide sufficient information on the drug indication, dose, duration , monitoring and any further necessary dose adjustments
Require the first prescription to be written by the specialist  

Amber Recommended

Drugs suitable for primary care prescribing following specialist recommendation
As for amber initiation except that:- The first prescription may be written by the GP after specialist recommendation.  

Green

Drugs for which primary care prescribers would normally take full responsibility for prescribing and monitoring
Drugs not included in the Traffic Light list but included on joint formulary.
New drugs classified as red or amber but as greater experience regarding their safety and efficacy is established may move to Green after re-consideration by the MVG and APC.  

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