| Formulary Chapter 4: Central nervous system - Full Chapter
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 Administration of depot antipsychotic injections during COVID-19 in stable adult patients |
| Details... |
| 04.06 |
Drugs used in nausea and vertigo |
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Dexamethasone
(tablets)
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Formulary
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For resistant nausea and vomiting only
£££££
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 Primary care summary - Dexamethasone in the treatment of COVID-19
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| 04.06 |
Palliative care |
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Cyclizine
(Injection)
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Formulary
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For use in palliative care only
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Dexamethasone
(Injection)
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Formulary
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For use in palliative care only
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| 04.06 |
Antihistamines |
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Cinnarizine
(Tablets)
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Formulary
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Cyclizine
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Formulary
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Tablets
Injection - for use in palliative care only
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Promethazine hydrochloride
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Formulary
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| 04.06 |
Phenothiazines and related drugs |
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Levomepromazine
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Formulary
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For palliative care only
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Prochlorperazine
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Formulary
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Inappropriate for elderly patients
Tablets
Buccal tablets
Syrup
Injection
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Chlorpromazine hydrochloride
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Formulary
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For nausea
Hyperemesis in pregnancy (off label use)
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| 04.06 |
Domperidone and metoclopramide |
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Domperidone
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Formulary
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Tablets - short term use only
Suppositories
SF suspension £££££ - for patients with swallowing difficulties only
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MHRA: New advice for domperidone (April 2014)
NICE: Promoting tolerance of enteral feeds in children and young people: domperidone
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Metoclopramide
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Formulary
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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
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MHRA: Restricted dose and duration of use (August 2013)
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Metoclopramide
(injection)
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Formulary
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 Palliative care
 All other indications
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| 04.06 |
5HT3 antagonists |
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Granisetron
(tablets)
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Formulary
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Hospital only
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Granisetron (Sancuso®)
(Transdermal patch)
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Formulary
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Hospital use only for oncology patients
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Ondansetron
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Formulary
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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)
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Palonosetron (Aloxi®)
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Formulary
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| 04.06 |
Neurokinin receptor antagonist |
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Aprepitant (Emend®)
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Formulary
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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
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| 04.06 |
Cannabinoid |
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| 04.06 |
Hyoscine |
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Hyoscine Hydrobromide
(300 microgram tablets)
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Formulary
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 UKMI Q&A: Hypersalivation – can hyoscine hydrobromide be used to treat it?
UKMI Q&A: Hypersalivation treatment options
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Hyosine (Scopaderm)
(Patch)
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Formulary
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£££££
1.5mg patch releases 1mg of hyoscine over 72 hours
Tablets more cost effective
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UKMI Q&A: Hypersalivation treatment options
UKMI Q&A: Hypersalivation-can hyoscine hydrobromide be used to treat it?
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| 04.06 |
Other drugs for Ménière's disease |
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Betahistine Dihydrochloride
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Formulary
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Ménière's disease, vertigo
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| Non Formulary Items |
Chlorpromazine Hydrochloride
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Non Formulary
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Cinnarizine and Dimenhydrinate (Arlevert®)
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Non Formulary
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Dolasetron Mesilate (Anzemet®)
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Non Formulary
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Doxylamine/pyridoxine (Xonvea ®)
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Non Formulary
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Non-formulary June 2019 |
NICE ES20: Doxylamine/pyridoxine (Xonvea) for treating nausea and vomiting of pregnancy
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Droperidol (Xomolix®)
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Non Formulary
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Fosaprepitant (Ivemend®)
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Non Formulary
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Nabilone
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Non Formulary
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Palonosetron
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Non Formulary
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Perphenazine
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Non Formulary
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Promethazine Teoclate (Avomine®)
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Non Formulary
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Tropisetron (Navoban®)
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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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