TRUST MEDICINES FORMULARY

This Formulary details those psychotropic medicines that may be prescribed within the Trust (on hospital prescriptions and FP10s) and recommended to be prescribed across South West London and should be read in conjunction with the Shared care for Psychotropics with Primary care and the ‘off-label’ policies.

The Formulary contains:

  • formulations that are available within the Trust
  • prescribing restrictions / guidelines that apply to that medicine within the Trust
  • additional information pertinent to the safe & effective use of the medicine
  • Medicines in the same order as the British National Formulary (BNF), with headings
  • Only psychotropic medicines (see local Hospital Formularies for medicines for physical complaints).
  • Nicotine replacement treatments follow Wandsworth CCG formulary (includes bupropion and varenicline and other treatments)
  • Compliance with NICE Technology Appraisal Guidance.

Non-formulary psychotropic medicines
Agomelatine
Aripiprazole Depot
Asenapine
Duloxetine
Escitalopram (except OCD/BDD)
Loxapine inhalation
Lurasidone
Olanzapine palmoate
Oxazepam
Paliperidone (oral) / Medicines removed from the formulary:
Benperidol -July 2010
Benzatropine -July 2011
Chloralhydrate -Nov 2009
Chlormethiazole –Sept 2015
Concerta (except 27mg) –Dec 2015
Dosulepin (Dothiepin) -2007
Droperidol -2001
Melatonin (Unlicensed) –July 2011
Nefazodone -January 2003 / Olanzapine short acting inj. -Dec 2013
Orphenadrine -Sept 2013
Promazine -Dec 2013
Reboxetine -July 2011
Risperidone long-acting injection - April 2011
Ritalin-SR -July 2011
Temazepam -Feb 2014
Thioridazine - 2005
Zotepine - July 2011 / Medicines Added to the Formulary since April 2015:
Lisdexamfetamine –Oct 2015
Nutrition & dietetic products-Apr 2015
Vortioxetine-Feb 2016
Xenidate®-Apr 2015

Further advice & Information

  • Contact your local Mental Health Pharmacist or Medicines Information on 020 3513 6829 for help and advice.
  • The Trust has a formulary policy (available on the Trust’s intranet and website), and application forms for non-formulary medicines for specific patients (SDTC2) or for inclusion in to the formulary (SDTC1) .
  • Trust Prescribing guidanceis available on the Medicines and Prescribing subsite, the Policies section of the intranet or website.
  • See the BNF, BNFc and Manufacturers Summary of Product Characteristics for full prescribing details.Numbering refers to eBNF.

3.4.1 Sedating antihistamines
Medicine / Formulations / Restrictions / Additional information
Promethazine hydrochloride / tablet 10mg, 25mg
liquid 5mg / 5ml
injection 25mg/mL

4.1 Hypnotics & Anxiolytics

/

See Trust policy TWC21x

Nitrazepam
/ tablet 5mg,
liquid 2.5mg / 5ml / Use with caution & at lower dosage in the elderly (see BNF)

Non-benzodiazepine hypnotics & other sedatives

/

See Trust policy TWC21x

Zopiclone / tablet 3.75mg
tablet 7.5mg / *1st line / Controlled Drug
See NICE TA77: Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomia
Zolpidem / tablet 5mg
tablet 10mg / *2nd line after zopiclone / Controlled Drug
See NICE TA77
Melatonin / tablets 2mg MR (Circadin®) / School-age children with developmental disability. / Unlicensed formulations from Hospital only.
4.1.2 Anxiolytics

Diazepam

/ tablet 2mg, 5mg, 10mg. liquid 2mg/5ml, 5mg/5ml. injection emulsion 5mg/ml, rectal solution 5mg, 10mg / Injection (emulsion) intravenous (IV) only

Chlordiazepoxide

/ capsule 5mg, 10mg / For alcohol detoxification regimens only
Lorazepam / tablet 1mg, 2.5mg
injection: 4mg /1ml. 2mg/1ml (does NOT require dilution)* / IM gluteal injection only or deltoid when safe to do so / 4mg/1ml injection: dilute 1:1 with water for injection / sodium chloride 0.9%
Imported from outside the EU.

4.2 Medicines used in psychoses and related disorders

4.2.1 Antipsychotic Medicines / See Trust policy TWC21c.
NOT to be used for night sedation.
Hospital only: mania in Children

Medicine

/ Formulations / Restrictions / Additional information

Chlorpromazine

/ tablet 10mg, 25mg,
50mg, 100mg
liquid 25mg/5ml,
100mg/5ml

Flupentixol dihydrochloride

/ 3mg tablet

Haloperidol

/ capsule 500microg,
tablet 1.5mg, 5mg, 10mg
liquid 5mg/5ml, 10mg/5ml
injection 5mg/1ml / Pre-treatment ECG required

Sulpiride

/ tablet 200mg, 400mg
liquid 200mg / 5ml / 200mg tablets are 1st line

Trifluoperazine

/ tablet 1mg, 5mg**
liquid 5mg/5ml / **Manufacturing delays frequent consider switching to another medicine.
Zuclopenthixol acetate
(“Clopixol Acuphase”) / injection 50mg, 100mg / Hospital only. For use in patients requiring or may require repeated IM injections and are refusing oral medicines
Zuclopenthixol dihydrochloride / tablet 2mg,10mg, 25mg
Atypical Antipsychotics
Amisulpride / tablet 50mg, 200mg, 400mg
liquid 100mg / 1ml
Aripiprazole / tablet 5mg, 10mg, 15mg
orodisp tab. 10mg, 15mg injection 7.5mg in 1ml / *Not 1stline for any indication
Max recommended 10-15mg/day in schizophrenia / Use liquid only if doses are <2.5mg/day
See NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 – 17 years
See NICE TA292: Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I
Clozapine / tablet 25mg, 100mg (Zaponex)
liquid 50mg/mL(Denzapine) / See Trust Clozapine Guide / Monitoring systems used: Zaponex Treatment Access System (ZTAS) for tablets. Denzapine Monitoring Service (DMS) for liquid.

Medicine

/ Formulations / Prescribing restrictions / Additional information
Olanzapine / tablet 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg
dispers. tablet 5mg, 10mg, 15mg / Orodispersible for dyspahgia or supervised administration only
Quetiapine / tablet 25mg, 100mg, 150mg, 200mg, 300mg / Requires twice daily dosage
M/R tablets 50mg, 200mg, 300mg, 400mg / For community team use for supervised administration only, not for discharge.
Risperidone (oral) / tablet 500microg, 1mg, 2mg, 3mg, 4mg, 6mg
dispers. tablet 1mg, 2mg,3mg, 4mg. liquid 1mg / 1ml / 1st line atypical antipsychotic.
Orodispersible for dyspahgia or supervised administration only / Optimum oral dosage 4-6mg per day in schizophrenia.

4.2.2. Antipsychotic Depot Injections

/ See TWC21b for administration details
Flupenthixol decanoate / 20mg/1ml, 40mg/2ml, 50mg/0.5ml, 100mg/1ml, 200mg/1ml.
Fluphenazine decanoate / 12.5mg/0.5ml, 25mg/1ml, 50mg/0.5ml &100mg/1ml
Haloperidol decanoate / 50mg/1ml, 100mg/1ml
Pipotiazine palmitate / 50mg/1ml, 100mg/2ml / Not for new initiations.
Zuclopenthixol decanoate / 200mg/1ml, 500mg/1ml
Paliperidone palmitate / 50mg, 75mg, 100mg, 150mg / Schizophrenia: either side effects from current depot, compliance problems with oral atypical or at patient request / Complete monitoring form before prescribing.
Complete SDTC2 if patient does not meet Trust prescribing criteria.
4.2.3 Antimanic Medicines

Medicine

/ Formulations / Prescribing restrictions / Additional information
Carbamazepine / See Section 4.8 - Antiepileptic Medicines below
Lamotrigine / See Section 4.8 - Antiepileptic Medicines below
Sodium valproate / See Section 4.8 - Antiepileptic Medicines below
Should not be used during pregnancy and in women of child-bearing potential unless clearly necessary i.e. in situations where other treatments are ineffective or not tolerated
Lithium carbonate / “Priadel” tablet MR 200mg, 400mg / (MR = modified release)
Lithium citrate / Liquid 10.8mmol Li / 5ml (“Li-liquid”) / 10.8mmol/5ml = 400mg lithium carbonate
Semisodium valproate / tablet e/c 250mg, 500mg / 2nd line valproate preparation / Prescribe as “Depakote – semisodium valproate” to avoid confusion with Epilim
Should not be used during pregnancy and in women of child-bearing potential unless clearly necessary i.e. in situations where other treatments are ineffective or not tolerated

4.3 Antidepressant Medicines

4.3.1Tricyclic & related antidepressant Medicines

Amitriptyline

/ tablet 10mg, 25mg, 50mg
liquid 50mg / 5ml
Clomipramine / caps 10mg, 25mg, 50mg
Imipramine / tablet 10mg, 25mg
liquid 25mg / 5ml
Lofepramine
/ tablet 70mg
liquid 70mg / 5ml
Nortriptyline / tablet 10mg, 25mg
Trimipramine / tablet 10mg, 25mg
capsule 50mg
Trazodone / capsule 50mg,100mg
liquid 50mg / 5ml / Not first-line treatment
4.3.2 Monoamine – oxidase inhibitors (MAOIs)
Phenelzine / tablet 15mg / Not first-line treatment /  BNF: “less suitable for prescribing”
 Isocarboxazid / tablet 10mg / Not first-line treatment /  BNF: “less suitable for prescribing”
 Tranylcypromine / tablet 10mg /
Not first-line treatment
/  BNF: “less suitable for prescribing”
Reversible MAOIs
Moclobemide / tablet 150mg / Not first-line treatment
4.3.3 Selective serotonin re-uptake inhibitors

Medicine

/ Formulations / Prescribing restrictions / Additional information
Citalopram / tablet 10mg, 20mg / 1st line antidepressant
Fluoxetine
/ capsule 20mg liquid 20mg / 5ml / 1st line antidepressant
Paroxetine
/ tablet 20mg, 30mg liquid 10mg / 5ml
Sertraline
/ tablet 50mg, 100mg
Escitalopram
/ Tablet 5mg, 10mg, 20mg / For use on “National OCD service recommendation” only
4.3.4 Other antidepressant Medicines
Mirtazapine / orodispersible tablet 15mg, 30mg, 45mg / Not first-line treatment
Venlafaxine / tablet 37.5mg, 75mg
MR caps(hospital only) MR 75mg, 150mg.
MR tabs (community only) / Not first-line treatment / MR = modified release, used only where the patient chooses
Vortioxetine / Tablet 5mg, 10mg, 20mg / *Not first-line treatment / Restricted to major depressive episodes in adults whose condition has responded inadequately to two antidepressants within the current episode.
See NICE TA367
4.4 Central Nervous System Stimulants and other Medicines used for attention deficit hyperactivity disorder See TWC21s

Atomoxetine

/

capsule 10mg, 18mg, 25mg, 40mg, 60mg

/ Specialist ADHD prescriber initiation only. / *Third line, after methylphenidate and dexamfetamine (unless there are anxiety issues or risk of diversion)
See NICE TA98Methylphenidate, atomoxetine and dexamfetamine for ADHD in children and adolescents
Dexamfetamine sulphate
/ tablet 5mg / Controlled Drug
See NICE TA98
Lisdexamfetamine
/ capsules 30mg, 50mg, 70mg / Controlled Drug, 2nd line
Methylphenidate hydrochloride / tablet 5mg, 10mg / Controlled Drug
See NICE TA98
Methylphenidate hydrochloride / Xenidate, Concerta 27mg (only), Equasym , Medikinet XL / Controlled Drug
*1st line preparation, Xenidate
See NICE TA98
4.8 Antiepileptics (treatment / prevention of psychiatricsymptoms)
Carbamazepine / tablet 100mg, 200mg, 400mg
tablet MR 200mg, 400mg
liquid 100mg / 5ml / Licensed for “prophylaxis of bipolar disorder not responsive to lithium.”
Recommended in NICE Bipolar guideline
Clonazepam / tablet 500microgram, 2mg / Use other than for epilepsy is an unlicensed indication
Lamotrigine / tablet 25mg, 50mg, 100mg, 200mg
dispers. tab. 5mg, 25mg, 100mg / Use other than for epilepsy is an unlicensed indication
Recommended in NICE bipolar guideline
Midazolam / Buccolam 2.5mg, 5mg, 7.5mg and 10 mg oromucosal solution / Available for conscious sedation according to Trust guidelines
Pregabalin / Capsules 25mg, 100mg, 300mg / 3rd line as per NICE for GAD, initiation form to be completed.
Sodium valproate / tablet 100mg, 200mg, 500mg
tablet MR 200mg, 300mg, 500mg
liquid 200mg / 5ml / 1st line valproate preparation / Endorse with ‘Epilim’ to avoid errors.
Should not be used during pregnancy and in women of child-bearing potential unless clearly necessary i.e. in situations where other treatments are ineffective or not tolerated

4.9 Medicines used in parkinsonism and related disorders

4.9.2 Antimuscarinic Medicines used in parkinsonism

Medicine

/ Formulations / Prescribing restrictions / Additional information
Procyclidine / tablet 5mg
liquid 5mg / 5ml
injection 5mg / 1ml
Trihexyphenidyl (Benzhexol) / tablet 2mg, 5mg

4.10 Medicines used in substance dependence

Alcohol dependence / See blue book & Trust policy
Acamprosate
/
tablet 333mg
/ Initiation by Addictions teams only / Patient must be engaged with a form of psychosocial support provided by Community Alcohol team or similar to initiate this medicine.
See NICE TA115: Naltrexone for the management of opioid dependence
See NICE TA325: Nalmefene for reducing alcohol consumption in people with alcohol dependence
Disulfiram
/ tablet 200mg / Initiation by Addictions teams only
Naltrexone / tablet 50mg /
Initiation by Addictions teams only
Nalmefene / tablet 18mg /
May be initiated by GPs only.
Opioid dependence
Buprenorphine
/ tablet sublingual 8mg, 2mg & 400microgram /

Initiation by Addictions teams only

/ Ensure opiate detox brand is used (i.e.not Temgesic analgesic)
Controlled Drug
See NICE TA114 Methadone and buprenorphine for the management of opiod dependence

Buprenorphine/naloxone

/ tablets
2mg/500microrams
8mg/2mg /

Initiation by Addictions teams only

Substitution treatment for opiod dependence in the framework of medical psychological and social treatment for patients over 15yrs who have agreed to treatment. /
  • Those with a history crushing and injecting tablets
  • Known to divert prescribed medication
  • Unable to comply with supervised consumption of buprenorphine in first 3 months of treatment due to work or child care commitments or physical disability
  • Transferred from another service already initiated on Suboxone®.
  • Controlled Drug

Lofexidine

/ tablet 200micrograms /

Initiation by Addictions teams only

Methadone / liquid “mixture” 1mg /1ml (sugar free) / Controlled Drug
See NICE TA114
Methadone / Tablet 5mg / Addictions teams only / Controlled drug, as an option for overseas travel where large volumes of methadone liquid would be impractical
See NICE TA114
Naltrexone / tablet 50mg /

Initiation by Addictions teams only

/ See TA115Naltrexone for the management of opioid dependence

Medicine

/ Formulations / Prescribing restrictions / Additional information

4.11 Medicines for dementia

/ See TWC21q sharedcare for antidementia medicines

Donepezil

/ tablet 5mg, 10mg
orodisp tablet 5mg, 10mg / Older peoples & LDteams only / 1st Line
See NICE TA217 Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimers disease
Galantamine / tablet 4mg, 12mg / Older peoples & LD teams only / See NICE TA217
Rivastigmine / capsule 1.5mg
liquid 2mg / 1ml
patch 4.6mg/24hours & 9.5mg /24 hours /

Older peoples & LD teams only

/ See NICE TA217
Memantine / Tablet 10mg, 20mg
Liquid 5mg/pump /

Older peoples & LD teams only

/ See NICE TA217

9.6.7 Multivitamin preparations

Sanatogen Gold

/ tablet / Eating disordersinpatient service only / For use alongside an emergency diet in patients at risk of re-feeding syndrome
1.3.2 Selective antimuscarinics
Pirenzapine / tablet 50mg / Antipsychotic induced sialorrhoea, 2nd line / See Trust ‘off-label’ list appendix 1 of TWC21k.
Imported from within the EU.
Hyoscine hydrobromide / tablet 500micrograms / Antipsychotic induced sialorrhoea, 1st line / See Trust ‘off-label’ list appendix 1 of TWC21h.
Atropine / 1% eyedrops / Antipsychotic induced sialorrhoea,used in water or sublingually, 2nd line / See Trust ‘off-label’ list appendix 1 of TWC21h.

Nutritional feeds used by the inpatient mental health service only:

Tube feeds:

Nutrison Standard 1.0 kcal/ml

Nutrison Energy 1.5k kcal/ml

Nutrison Multifibre 1.0 kcal/ml

Nutrison Energy Multifibre 1.5 kcal/ml.

Oral Nutrition Support products

Skandishake

Fortisip

Fortisip Multi Fibre

Fortisip Compact

Fortisip Compact Fibre

Fortimel

Fortisip Yoghurt Style

Fortisip Savoury Multi Fibre

Fortijuice

Calogen

Calogen Extra shot

Forticreme Complete

Fortisip Fruit Dessert

Complan Shake

Thickener/thickened products

Nutilis clear

Nutilis Complete

Complan

DTC Feb2016*If clinically indicated or another preparation if the patient insists.