| Formulary Chapter 4: Central nervous system - Full Chapter
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 Administration of depot antipsychotic injections during COVID-19 in stable adult patients |
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| 04.02 |
Drugs used in psychoses and related disorders |
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| 04.02.01 |
Antipsychotic Drugs |
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Chlorpromazine
(tablets & syrup)
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Formulary
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Supported by an ESCA
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ESCA: Oral antipsychotics
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Chlorpromazine
(injection)
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Formulary
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Not to be used for psychiatric / anxiolytic purposes in Primary Care
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Flupentixol
(tablets)
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Formulary
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Supported by ESCA
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ESCA: Oral antipyschotics
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Haloperidol
(Oral)
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Formulary
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 tablets
capsules
SF liquid
Supported by an ESCA
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ESCA: Oral antipsychotics
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Haloperidol
(injection)
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Formulary
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For rapid tranquilisation
Not to be used for psychiatric / anxiolytic purposes in Primary Care
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Levomepromazine
(tablets)
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Formulary
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Supported by ESCA
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ESCA: Oral antipsychotics
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Levomepromazine
(injection)
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Formulary
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Not to be used for psychiatric / anxiolytic purposes in Primary Care
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Penfluridol
(Oral)
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Formulary
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Pericyazine
(Oral)
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Formulary
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Supported by ESCA
£££££
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ESCA: Oral antipsychotics
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Perphenazine
(Oral)
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Formulary
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Supported by ESCA
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ESCA: Oral antipsychotics
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Sulpiride
(Oral)
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Formulary
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Supported by ESCA
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ESCA: Oral antipsychotics
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Trifluoperazine
(Oral)
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Formulary
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tablets
SF solution
Supported by ESCA
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ESCA: Oral antipsychotics
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Zuclopenthixol
(tablets)
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Formulary
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Supported by ESCA
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ESCA: Oral antipsychotics
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| 04.02.01 |
Second-Generation Antipsychotic Drugs |
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Amisulpride
(tablets and solution)
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Formulary
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Supported by ESCA
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ESCA: Oral Antipsychotics
NICE CG178: Psychosis and schizophrenia in adults
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Aripiprazole
(tablets)
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Formulary
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- Supported by ESCA
- Use in Tourette's syndrome approved
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ESCA: Oral Antipsychotics
NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years (NICE TA 213)
NICE TA292: Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder
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Olanzapine
(tablets and orodispersible tablets)
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Formulary
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Supported by ESCA
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CG 178: Psychosis and schizophrenia in adults
ESCA: Oral Antipsychotics
NICE CG38:Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care
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Quetiapine
(standard release tablets)
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Formulary
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- Prescribe standard release tablets
- Supported by ESCA
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CG178: Psychosis and schizoprenia in adults
ESCA: Oral Antipsychotics
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Quetiapine
(modified release preparations)
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Formulary
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- 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
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ESCA: Oral Antipsychotics
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Risperidone
(tablets/liquid)
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Formulary
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Supported by ESCA
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CG178: Psychosis and schizophrenia in adults
ESCA: Oral Antipsychotics
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Clozapine
(Tablets)
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Formulary
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Specialist initiation and maintenance only
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| 04.02.02 |
Antipsychotic depot injections |
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Aripiprazole (Abilify Maintena®)
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Formulary
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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
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Flupentixol Decanoate
(injection)
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Formulary
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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
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Fluphenazine Decanoate (Modecate®)
(injection)
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Formulary
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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
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Haloperidol (Haldol Decanoate®)
(injection)
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Formulary
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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
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Olanzapine Embonate (ZypAdhera®)
(Injection )
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Formulary
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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
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Paliperidone ( Xeplion®)
(Monthly depot injection)
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Formulary
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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
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Paliperidone (Trevicta®)
(Three-monthly depot injection)
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Formulary
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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
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Risperidone (Risperdal Consta®)
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Formulary
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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
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Zuclopenthixol Decanoate
(injection)
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Formulary
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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
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| 04.02.03 |
Drugs used for mania and hypomania |
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Lamotrigine
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Formulary
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On specialist advice.
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| 04.02.03 |
Drugs to manage Antipsychotic side effects |
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Procyclidine
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Formulary
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Hyoscine
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Formulary
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For hypersalivation caused by antipsychotics in line with Green status for hypersalivation use in Parkinson's Disease
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Trihexyphenidyl
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Formulary
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Pirenzipine (unlicensed)
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Formulary
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Hospital use only
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| 04.02.03 |
Carbamazepine |
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Carbamazepine
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Formulary
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On specialist advice
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| 04.02.03 |
Valproic acid |
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Valproic Acid (Depakote®)
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Formulary
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 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
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 Guidance Document on Valproate Use in Women and Girls of Childbearing Years (March 2019)
Valproate form: Annual Risk Acknowledgement form (March 2019)
MHRA: Valproate use in women and girls (August 2018)
NICE CG38: Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care
Women of childbearing potential: Educational Risk Minimisation Materials
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| 04.02.03 |
Lithium |
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Lithium Carbonate
(M/R tablets)
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Formulary
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- 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
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ESCA: Black Country - Lithium (GP Monitoring)
ESCA: Black Country - Lithium (Hospital Monitoring)
ESCA: Lithium
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Lithium Citrate
(liquid)
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Formulary
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- 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
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ESCA: Black Country - Lithium (GP Monitoring)
ESCA: Black Country - Lithium (Hospital Monitoring)
ESCA: Lithium
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| Non Formulary Items |
Asenapine
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Non Formulary
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Hospital use only |
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Benperidol (Anquil®)
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Non Formulary
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Clonazepam
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Non Formulary
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Flupentixol (Fluanxol®)
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Non Formulary
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Fluphenazine Hydrochloride (Moditen®)
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Non Formulary
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Lurasidone (Latuda®)
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Non Formulary
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Methysergide (Deseril®)
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Non Formulary
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Orphenadrine
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Non Formulary
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Discontinued by manufacturer |
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Paliperidone
(Oral)
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Non Formulary
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Pimozide (Orap®)
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Non Formulary
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Pipotiazine Palmitate (Piportil® Depot)
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Non Formulary
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Pregabalin
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Non Formulary
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NHS England: (Schedule 3 Controlled Drugs) Patient Leaflet; Are you taking gabapentin or pregabalin? (Lyrica, Alzain, Neurontin)
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Prochlorperazine
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Non Formulary
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Promazine Hydrochloride (Promazine®)
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Non Formulary
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Sertindole (Serdolect®)
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Non Formulary
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Sodium valproate
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Non Formulary
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Topiramate
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Non Formulary
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Ziprasidone (Zeldox®)
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Non Formulary
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Zotepine
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Non Formulary
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Discontinued in 2011 |
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Zuclopenthixol Acetate (Clopixol Acuphase®)
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Non Formulary
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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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Cancer Drugs Fund |
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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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| Status |
Description |
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All Settings
Suitable for initiation, ongoing prescribing, and discontinuation in both primary and secondary care settings. They are generally familiar, frequently used therapies that can be started within their licensed indications without specialist oversight. |
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Specialist only
Designated for initiation, ongoing prescribing, monitoring, exclusively by a specialists either in a hospital or as part of a specialist service (to note this could be in a non-hospital setting). Primary care should neither start nor continue these treatments except as part of a specialist service. A specialist could be either a medical or non-medical prescriber. |
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Specialist advice
Prescribers in primary care should seek advice and a recommendation from a specialists prior to initiating a medicine. Once agreed with a specialist, medicines can be initiated, prescribed and monitored in primary care without a formal shared-care agreement. |
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Specialist initiation
Medicines in this category require a specialist to start therapy, titrate dosage, and assess initial efficacy or tolerability. Once stabilised, prescribing responsibility may transfer to primary care without the need for a formal shared-care agreement. |
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Shared care agreement
Prescribing responsibility can be shared across health settings and between specialists and GPs only when formal shared care arrangement has been made. For example, there may be extensive and complex monitoring requirements or significant safety concerns (note would need a national policy on this to define the criteria for requiring a formal SCA), this will be produced once nationally. |
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Do not prescribe
Not approved for routine prescribing in primary or secondary care. For example, because they are agents classified in the BNF as “not NHS” or “Drugs of Low Clinical Value”, or they are products on NICE’s “do not do” list or NHS England’s “should not routinely prescribe” list. |
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Self Care
Not for routine prescribed in primary or secondary care unless as part of care for a long term condition. Instead, patients should be encouraged to self care with support from community pharmacy. |
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Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications |
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Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. |
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Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry. |
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Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
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Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
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Positive NICE TA and /or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
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Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use. |
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