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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.03.04  Expand sub section  Other antidepressant drugs
Agomelatine 25mg
(tablet)
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Restricted Drug Restricted

Red Traffic Light  For Generalised Anxiety Disorder: prescribing by Psychiatry team only. Used in accordance with guideline BHTCG 131FM.



Amber For treatment of depression, initiation by Psychiatry team, continuation by GPs in accordance with Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressant treatment algorithm (BHT 572FM).  Patients should remain under the care of an Oxford Health specialist until all scheduled LFT monitoring is complete and results are normal (minimum of 24 weeks, or for 24 weeks from the date of a dose increase). Only at this point, and only if the patient is well, should a patient be discharged back to GP care.

 
Link  Generalised Anxiety Disorder Guideline for Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 131FM)
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
Bupropion Hydrochloride 150mg (Zyban®)
(prolonged release tablet)
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Formulary

Red Traffic Light Restricted to secondary care consultant initiation and continuation as monotherapy or augmentation in treatment resistant depression, only where all other options have been excluded - see Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressant treatment algorithm (BHT 572FM).

 

Green Traffic Light For prescribing as part of the smoking cessation program - see section 04.10.02 Nicotine dependence. 

 
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
Duloxetine 30mg, 60mg
(capsule)
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Restricted Drug Restricted

Green Traffic Light Used as an alternative first line option when an SSRI is contraindicated for the treatment of Generalised Anxiety Disorder in accordance with guideline BHTCG 131FM.

Green Traffic Light Used as a third line option in accordance with the Depression in Adults and Older Adults guideline BHTCG 573FM and Antidepressants treatment algorithm BHT 572FM.

 
Link  Generalised Anxiety Disorder Guideline for Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 131FM)
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
Flupentixol 500micrograms, 1mg, 3mg
(tablet)
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Formulary
Green

See Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressant treatment algorithm (BHT 572FM).

 
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
Mirtazapine 15mg, 30mg
(tablets)
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Restricted Drug Restricted
Green

See Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressant treatment algorithm (BHT 572FM).

May be used as a first line antidepressant if the sedative effects would be particularly beneficial, or where concomitant medical conditions or concurrent medication make an SSRI less suitable. 

 
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
Mirtazapine 15mg, 30mg, 45mg
(orodispersible tablet)
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Formulary
Green

See Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressant treatment algorithm (BHT 572FM).

May be used as a first line antidepressant if the sedative effects would be particularly beneficial, or where concomitant medical conditions or concurrent medication make an SSRI less suitable.

 
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
Mirtazapine 15mg/1mL
(oral solution)
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Formulary
Green

Cheaper to use orodispersible where this is clinically appropriate. See Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressant treatment algorithm (BHT 572FM).

May be used as a first line antidepressant if the sedative effects would be particularly beneficial, or where concomitant medical conditions or concurrent medication make an SSRI less suitable.

 
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
Reboxetine 4mg
(tablet)
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Restricted Drug Restricted
Amber Initiation

Initiation in secondary care and continuation by GPs.  Reboxetine is not included in the Depression Guideline for routine treatment, as it has been shown to have a lower efficacy and tolerability profile when compared with other antidepressants.  Prescribing may continue in existing patients only where efficacy has been clearly demonstrated - for further information see Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressant treatment algorithm (BHT 572FM).

 
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
Venlafaxine 37.5mg, 75mg
(tablet)
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Restricted Drug Restricted
Green

For treatment of Depression as a third line option in accordance with the Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressant treatment algorithm (BHT 572FM).

 
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
Venlafaxine 75mg, 150mg
(MR capsule)
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Restricted Drug Restricted
Green

For treatment of;

1. Depression as a third line option in accordance with the Depression in Adults and Older Adults guideline (BHTCG 573FM) and Antidepressant treatment algorithm (BHT 572FM).

2. Generalised Anxiety Disorder as an alternative first line option if an SSRI is contraindicated in accordance with guideline BHTCG 131FM.

 
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
Link  Generalised Anxiety Disorder Guideline for Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 131FM)
   
Vortioxetine 5mg, 10mg, 20mg
(Tablet)
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Restricted Drug Restricted
Amber Recommended

Use in accordance with;

1. NICE TA367 -  Vortioxetine for treating major depressive episodes which recommends vortioxetine as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episode.

2. Depression in Adults and Older Adults guideline (BHTCG 573FM) and  Antidepressant treatment algorithm (BHT 572FM). 

 
Link  NICE TA367: Vortioxetine for treating major depressive episodes
Link  Depression in Adults and Older Adults - Primary/Secondary Care guideline (BHTCG 573FM)
Link  Antidepressant Treatment Algorithm - Primary/Secondary Care (BHT 572FM)
   
 ....
 Non Formulary Items
Tryptophan 500mg
(tablet)

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Non Formulary
Black

Not included in the OH Depression Guideline. Exceptional requests for use should be made using the OH Drugs & Therapeutics Group Non-Formulary Request form.

 
  
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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