Sandwell & West Birmingham CCG for patients seen by the Black Country ADHD Services.  

 REM sleep behaviour disorder and circadian rhythm sleep-wake disorder in adults in line with ESCA

   For all other indications

 REM sleep behaviour disorder and circadian rhythm sleep-wake disorder in adults in line with ESCA

   For all other indications

£££££

From Monday 1st June 2015, prescriptions for temazepam will be required to meet full prescription requirements for Schedule 3 controlled drugs (CDs)

Legislative changes to prescription writing requirements for temazepam

From Monday 1st June 2015, prescriptions for temazepam will be required to meet full prescription requirements for Schedule 3 controlled drugs (CDs)

Legislative changes to prescription writing requirements for temazepam

Inpatient use and prison settings only

Inpatient use and prison settings only

Adjunct in acute alcohol withdrawal

£££££

Second line

Supported by an ESCA

Not to be used for psychiatric / anxiolytic purposes in Primary Care

Supported by ESCA

For rapid tranquilisation

Not to be used for psychiatric / anxiolytic purposes in Primary Care

tablets
capsules
SF liquid
Supported by an ESCA

Supported by ESCA

Not to be used for psychiatric / anxiolytic purposes in Primary Care

Supported by ESCA

£££££

Supported by ESCA

Supported by ESCA

tablets
SF solution
Supported by ESCA

Supported by ESCA

Supported by ESCA

• Supported by ESCA
• Use in Tourette's syndrome approved

Supported by ESCA

• Prescribe standard release tablets
• Supported by ESCA

• Supported by ESCA
• Rationale for prescribing rather than first line antipsychotics to be provided with ESCA
  
  APC preferred brands, choose most cost effective option:
• Biquelle XL
• Sondate XL
• Zaluron XL
• Choose most cost-effective option

Supported by ESCA

Specialist initiation and maintenance only

The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer

HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED

The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer

HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED

The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer 

HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED

Discontinued by UK manufacturer by the end of 2018

The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer 

HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED

The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer

HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED

The APC’s view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer

HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED

The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer

HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED

The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer

HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED

The APC's view is that, on clinical grounds, the status of antipsychotic depot injections should be amber with a framework in place in Primary Care before transfer 

HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED

On specialist advice.

For hypersalivation caused by antipsychotics in line with Green status for hypersalivation use in Parkinson's Disease

Hospital use only

On specialist advice

 Use in men and women of non-child bearing potential

 Use in women and girls of childbearing potential (all indications).  ESCA link below

Contrindiciated in women of childbearing potential unless part of the Pregnancy Prevention Programme. See MHRA guidance

• Supported by ESCA-requires regular review in secondary care. Full discharge at 12 months
• APC preferred brand is Priadel, however there are other brands available and you should continue to prescribe the brand that the patient is stable on
• Below is an ESCA link for patients seen by the Black Country Mental Health Services 

• Supported by an ESCA-requires regular review in secondary care. Full discharge at 12 months
• APC preferred brand is Priadel, however there are other brands available and you should continue to prescribe the brand that the patient is stable on
• Below is an ESCA link for patients seen by the Black Country Mental Health Services

Tablets more cost effective than SF solution

Sugar Free solution £££££

An alternative to SSRIs in obsessive-compulsive disorder (OCD)

Tablets

Capsules

SF Liquid

Risk of QT prolongation

4 drops (8 mg) is equivalent in therapeutic effect to 10mg tablet

Risk of QT prolongation

In line with NICE

Specialist initiation and stabilisation before transfer to Primary Care

£££££

For generalised anxiety disorder

Please follow Optimise Rx for most cost effective brand

Supported by a RICaD (in development)

• Tablets
• Orodispersible tablets ££

1st choice = Vensir XL capsules (suggest switching generic prescriptions to this agent)
2nd choice = Venlalic XL tablets

Please note that commissioning discussion is underway. However the present status is as follows:-

  Age 6 and over - Solihull practices.  Supported with ESCA

 Age 16 and over - Birmingham practices.  Supported with ESCA

 Age under 16 - Birmingham practices

 Supported with an ESCA - Sandwell & West Birmingham CCG for patients seen by the Black Country ADHD Services

Please note that commissioning discussion is underway. However the present status is as follows:-

  Age 6 and over - Solihull practices.  Supported with ESCA

  Age 16 and over - Birmingham practices.  Supported with ESCA

 Age under 16 - Birmingham practices

  Supported with an ESCA - Sandwell & West Birmingham CCG for patients seen by the Black Country ADHD Services

For the treatment of ADHD in children and adolescents 6-17 years old for whom stimulants are not suitable, not tolerated or have been shown to be ineffective

Please note that commissioning discussion is underway. However the present status is as follows:-

 Age 6 and over - Solihull practices.  Supported with ESCA

 Age 16 and over - Birmingham practices.  Supported with ESCA

 Age under 16 - Birmingham practices

 Age 6 and over - Sandwell and West Birmingham CCG.  Supported with ESCA

Please note that commissioning discussion is underway. However the present status is as follows:-

 Age 6 and over - Solihull practices.  Supported with ESCA

 Age 16 and over - Birmingham practices.  Supported with ESCA

 Age under 16 - Birmingham practices

  Age 6 and over - Sandwell and West Birmingham CCG.  Supported with ESCA

  Supported with an ESCA -Sandwell & West Birmingham CCG for patients seen by the Black Country ADHD Services

                The immediate release preparation may be prescribed generically 
 

Please note that commissioning discussion is underway. However the present status is as follows:-

  Age 6 and over - Solihull practices.  Supported with ESCA

 Age 16 and over - Birmingham practices.  Supported with ESCA

 Age under 16 - Birmingham practices

 Age 6 and over - Sandwell and West Birmingham CCG.  Supported with ESCA

  Supported with an ESCA - Sandwell & West Birmingham CCG for patients seen by the Black Country ADHD Services

• Specialist initiation only for use in narcolepsy

In line with NICE

Can prescribe in accordance with NICE guidance

Orlistat 60mg capsules - Over the counter preparation suitable for self-care/purchase if appropriate

For resistant nausea and vomiting only

£££££

For use in palliative care only

For use in palliative care only

Tablets

Injection - for use in palliative care only

For palliative care only

Inappropriate for elderly patients

Tablets

Buccal tablets

Syrup

Injection

For nausea

Hyperemesis in pregnancy (off label use)

Tablets - short term use only

Suppositories

SF suspension £££££ - for patients with swallowing difficulties only

Tablets

SF solution £££££ - for patients with swallowing difficulties only

Nausea and vomiting

Not recommended for patients under 20 years of age due to risk of dystonic reactions 

For restrictions for use in younger patients see MHRA guidance below

Hospital only

Hospital use only for oncology patients

Preparations available:

• Tablets
• Melt tablets
• Suppositories
• Injection
• SF syrup- for patients with swallowing difficulties only
  
    Chemotherapy patients only
    Hyperemesis in pregnancy (off label)
    Palliative care (off label)

For use with chemotherapy only

For chemo-related nausea and vomiting

Second-line agent in patients who have failed with 5HT3 antagonist

Hospital use only

£££££

1.5mg patch releases 1mg of hyoscine over 72 hours

Tablets more cost effective

Ménière's disease, vertigo

For gargling - topical analgesia

Tablets

SF suspension

500mg soluble tablets - high sodium content. Only for patients with swallowing difficulties

£££££

Limited evidence

For elderly community who would not tolerate separate ingredients and to support a step down review

£££££

Limited evidence

Only for patients with swallowing difficulties

For elderly community who would not tolerate separate ingredients and to support a step down review

High sodium content

Tablets and capsules more cost effective

Use with caution in patients over 65s

Contraindicated in children below the age of 12

Use in chronic pain only

£££££

High sodium content 

Only for use in patients with swallowing difficulties

Tablets and capsules more cost effective

For use in chronic pain

ONCE A WEEK patch (7-day patch)

For specialist initiation: specialist pain clinics, palliative care and for patients with swallowing difficulties

Patches should be prescribed by BRAND

TWICE WEEKLY patch

For specialist initiation: specialist pain clinics, palliative care and for patients with swallowing difficulties

Patches should be prescribed by BRAND

Specialist use only

For use in opioid dependence, see section 4.10.3

Tablets

25mg/5ml syrup

Use with caution in patients aged over 65

Contraindicated in children below the age of 12

Tablets

Oral solution for patients with swallowing difficulties

For patients with swallowing difficulties on stable doses of opiates or on pain team specialist advice when morphine is not suitable.
Prescribe by brand.
Follow Optimise Rx advice for most cost effective brand

For use in opiod dependence, see section 4.10.3

  Tablets

                M/R tablets

                M/R capsules

                Oral solution

                Injection

  Suppositories

                100mg/100ml PCA

                5mg/5ml intrathecal injection

                pre-filled syringe

Specialist initiation- pain clinic

Modified release(MR) preparation should be used for regular dosing. Immediate release preparations may be associated with tolerance and problem drug use.

Follow Optimise Rx advice for most cost effective brand / formulation

Injectable formulations for palliative care only

Capsules

M/R tablets

SF solution

For patients who do not tolerate morphine

Specialist initiation
Pain clinic and palliative care use only

Third line after morphine and codeine

Please note modified release preparations are non-formulary

Third line after morphine and codeine

Only for patients with swallowing difficulties

Capsules more cost effective

1st line

Low abuse potential, low cost

Off label use

2nd line

Be aware of abuse and addiction potential associated with this class of agent

Due to the risk of adverse effects associated with Gabapentin,start with the lowest effective dose and titrate up to the minimum effective dose. Educate patient on titration
At follow up, check patient's tolerance of treatment and understanding of dose titration

See Gabapentin leave sheet for dose titration information

Reduce dose in renal impairment

Third line after gabapentin

On advice of specilaist - initiate at 30 mg OD for 1 month, then 60 mg OD

More cost effective options available

NICE suggests 1st line for Diabetic neuropathy

Low abuse potential , high cost £££££

Not licensed for use in children

4th line after duloxetine

On the advice of a specialist where duloxetine is unsuitable

Please be aware of abuse potential associated with this class of agent

From 17th July 2017, clinicians can now return to normal practice when prescribing pregabalin and no longer need to specify a brand name when prescribing for neuropathic pain

For the treatment of trigeminal neuralgia only

Baseline LFTs,FBC and U & Es- then 6 monthly

For local neuropthic pain

ONLY strength licensed for post-herpetic neualgia and diabetic peripheral polyneuropathy

For other strength, see section 10.3.2

Please note that capsaicin 8% patches are non-formulary

Approved only in patients who have been treated in line with NICE CG173: Neuropathic pain in adults: pharmacological management in non-specialist settings  but are still experiencing neuropathic pain associated with previous hepes zoster infection (post-herpetic neuralgia)

Following the policy - Items which should not routinely be prescribed in Primary Care. There is an exception for lidocaine for treatment of neuropathic pain in adults.

  Tablets
  Orodispersible tablets SF-reserved for patients who are vomiting due to migraine

  Wafer/oral lyophilisates SF £££££

Tablets (prescribe as generic)

Nasal spray £££££

Injection £££££

In line with NICE

In line with NICE

In line with NICE

For hospital use only

Use in line with NICE 

For migraine prophylaxis as per guidance

On specialist recommendation

Unlicensed medicine

Specialist use only

Tablets

M/R tablets

SF liquid

Suppositories

Tegretol is the preferred brand for new patients however please ensure that existing patients are maintained on a specific manufacturers brand

MHRA Advice
Patients being treated for epilepsy should be maintained on a specific manufacturer's product

Should only be considered following referral to a tertiary care specialists  and after oxcarbazepine has been tried

Supported by an ESCA

Tablets

Oral suspension

On specialist advice

MHRA Advice
Care should be taken when switching between oral formulations. The need for continued supply of a particluar manufacturer's product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

On specialist advice

MHRA Advice
When prescribing for epilepsy, the potential for clinically relevant differences to exist between different manufacturers' product is considered to be extremely low. However, consider otherpatient / carer related factors, such as negative perceptions about alternative products and/or other issues related to the patient such co-morbid autism, mental health issues, or learning disability

On advice of specialist

MHRA Advice
It is usually unnecessary to ensure that patients are maintained on a specific maufacturer's product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

On advice of specialist

Tablets £££££, capsules are more cost effective

MHRA Advice
For patients being treated for epilepsy , it is usually unnecessary to ensure that patiemts are maintained on a specific manufacturer's product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

On advice of specialist

Please follow Optimise Rx for most cost effective brand

Tablets

Syrup

Supported by an ESCA

Tablets

Dispersible tablets

On specialist advice

MHRA Advice
Care should be taken when switching between oral formulations. The need for continued supply of a particular manufacturer's product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

Tablets

SF oral solution

Coated granules in sachets (see Desitrend^®)

On specialist advice

MHRA Advice
It is usually unnecessary to ensure that patients are maintained on a specific manufacturer's product unless there are specific reasons such as patient anxiety and riak of confusion or dosing errors

Paediatrician initiation

For patients up to and including 16 years of age who are unable to swallow tablets and in whom the liquid formulation is not appropriate or tolerated

MHRA Advice
It is usually unnecessary to ensure that patients are maintained on a specific maufacturer's product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

On specialist advice with an ESCA 

MHRA Advice
When prescribing for epilepsy the patient should be assessed  to make a clinical judgement if the same manufacturer's product/brand is necessary taking into account factors such as seizure frequency and treatment history. Also take into account patient/carer related factors such as their negative perceptions about alternative products and/or other issues related to the patient such as co-morbid autism, mental health issues or learning disability

Tablets

Elixir

On specialist advice

MHRA Advice
Patients being treated for epilepsy should be maintained on a specific manufacturer's product

Safety Information 

Prescriptions for Phenobarbital for children should be prescribed as "unlicensed phenobarbital oral solution 50mg in 5ml (alcohol free)"   APC descision September 2021                                                               

On specialist advice

MHRA Advice
Patients being treated for epilepsy should be maintained on a specific manufacturer's product

Capsules

Suspension

On specialist advice

MHRA Advice
Patients being treated for epilepsy should be maintained on a specific manufacturer's product

For Lennox-Gastaut syndrome only

Supported by an ESCA

MHRA Advice
MHRA advises that when prescribing for epilepsy the patient should be assessed to make a clinical judgement if the same manufacturer's product/brand is necessary taking into account factors such as seizure frequency and treatment history. Also take into account patient/carer related factors such as their negative perceptions about alternative products and/or other issues related to the patient such as co-morbid autism, mental health issues or learning disability

On specialist advice

MHRA Advice
MHRA advises that when prescribing for epilepsy the patient should be assessed to make a clinical judgement if the same manufacturer's product/brand is necessary taking into account factors such as seizure frequency and treatment history. Also take into account patient/carer related factors such as their negative perceptions about alternative products and/or other issues related to the patient such as co-morbid autism, mental health issues or learning disability

E/C tablets

M/R tablets

Crushable tablets

SF liquid

M/R granules see Episenta^®

On specialist advice

 Use in men and women of non-child bearing potential

 Use in women and girls of childbearing potential (all indications).

Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme. See MHRA guidance

MHRA Advice
Care should be taken when switching between oral formulations. The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

Paediatrician initiation for patients with epilepsy aged up to and including 16 years of age unable to swallow tablets and who require a modified release formulation in whom other formulations are more expensive or not appropriate

Contraindicated in women of childbearing potential unless part of the Pregnancy Prevention Programme. See MHRA guidance

MHRA Advice
Care should be taken when switching between oral formulations. The need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

On specialist advice with an ESCA

On specialist advice with an ESCA

MHRA Advice
When prescribing for epilepsy the patient should be assessed  to make a clinical judgement if the same manufacturer's product/brand is necessary taking into account factors such as seizure frequency and treatment history. Also take into account patient/carer related factors such as their negative perceptions about alternative products and/or other issues related to the patient such as co-morbid autism, mental health issues or learning disability

On specialist advice

MHRA Advice
Care should be taken when switching between oral formulations. The need for continued supply of a particluar manufacturer's product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

On specialist advice

MHRA Advice
Care should be taken when switching between oral formulations. The need for continued supply of a particluar manufacturer's product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

•Initiation by Tertiary Epilepsy Specialist only.
•For adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adult and adolescent patients from 16 years of age with severe refractory epilepsy warranting tertiary specialist input for patients who have tried three or more AEDs. The patient has used levetiracetam and has documentation of intolerance and patient is using a third line agent (perampanel, zonisamide, lacosamide, eslicarbazepine) which would be replaced by brivaracetam

Supported by an ESCA

In line with NICE

In line with NICE

Severe myoclonic epilepsy of infancy (Dravet syndrome)
APC supports use in Adults: for continuation of therapy started in childhood. (Note Off Label use in adults)

On specialist advice

• solution for injection in cartridge
• solution for infusion (accepted July 2020)

Please note that MODIFIED RELEASE preparation's are non-formulary and for existing patients only

For use in Restless Legs, supported by an ESCA, see link below

Brand preference SWB CCG Ippinia XL® (September 2020)

Capsules

M/R capsules

Dispersible tablets

Tablets

M/R tablets

Tablets

Oral lyophilisate are reserved for patients with swallowing difficulties in advanced Parkinson's disease

Second-line therapy to entacapone, in patients who fail to respond to, or are intolerant of, entacapone, in situations where apomorphine therapy has been considered

Supported by an ESCA

Capsules

Syrup - for patients with swallowing difficulties 

Injection

Tablets

SF syrup

Tablets

Tablets

Oral solution

Supported by an ESCA

Tablets

For use in Restless Legs, supported by an ESCA, see link below

For initiation by specialists in substance misuse

Adjunct in acute alcohol withdrawal

Restricted to Specialist Substance Misuse Services only (as per the local authority public health approved pathways)

Reach Out Recovery (CRI) in Birmingham. Single point of contact 24/7 Tel: 0121 227 5890 Link Reach Out Recovery website

Swanswell in Sandwell Tel: 0121 553 1333 Link to Swanswell website

SIAS in Solihull Tel:0121 301 3600 Link to SIAS website

The Nalmefen for reducung alcohol consumption technology appraisal (TA325) recommends this drug as a possible treatment for people with alcohol dependence who:

• are still drinking more than 7.5 units per day (men) and more than 5 units per day (women) 2 weeks after an initial assessement and
• do  not have physical withdrawal symptoms and
• do not need to either stop drinking straight away or stop drinkling completely

The guidance also recommends that nalmefene should only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption

Useful as an adjunct in the treatment of alcohol dependence after a successful withdrawal

For use under specialist addiction services

For use under specialist addiction services

Used to reverse opioid overdose

On recommendation from specialist service

• Tablets
• Orodispersible 10mg tablets sugar free (pack of 28)

• Tablets
• M/R capsules
• Oral solution

• Tablets

• Capsules
• Patches - preferred brand is Alzest®

In line with NICE

£££££

Specilaist initiation and stabilisation

Approved on formualry December 2017

Specialist use only for neurological conditions

Specialist use only for neurological conditions

Specialist use only for neurological conditions

Specialist use only for neurological conditions

Specialist use only for neurological conditions