| 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... |
| 04.09 |
Drugs used in parkinsonism and related disorders |
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Parkinson's Disease must be confirmed by a consultant neurologist |
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| 04.09.01 |
Dopaminergic drugs used in Parkinsons disease |
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| 04.09.01 |
Dopamine receptor agonists |
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Apomorphine (APO-Go®)
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Formulary
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Apomorphine (Dacepton®)
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Formulary
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- solution for injection in cartridge
- solution for infusion (accepted July 2020)
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Pramipexole
(Immediate release)
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Formulary
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Please note that MODIFIED RELEASE preparation's are non-formulary and for existing patients only
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Ropinirole
(Tablets)
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Formulary
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For use in Restless Legs, supported by an ESCA, see link below
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ESCA: Ropinerole in Restless Legs syndrome
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Ropinirole
(M/R tablets)
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Formulary
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Brand preference SWB CCG Ippinia XL® (September 2020)
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Rotigotine
(Patches)
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Formulary
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| 04.09.01 |
Levodopa |
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Co-beneldopa
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Formulary
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Capsules
M/R capsules
Dispersible tablets
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UKMI Q&A: How do you convert from co-beneldopa (Madopar®) prolonged-release capsules to dispersible tablets?
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Co-careldopa
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Formulary
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Tablets
M/R tablets
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Co-Careldopa and Entacapone (Stalevo)
(Tablets)
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Formulary
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| 04.09.01 |
Monoamine-oxidase-B inhibitors |
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Rasagiline (Azilect®)
(Tablets)
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Formulary
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Selegiline Hydrochloride
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Formulary
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Tablets
Oral lyophilisate are reserved for patients with swallowing difficulties in advanced Parkinson's disease
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| 04.09.01 |
Catachol-O-methyltransferase inhibitors |
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Entacapone
(Tablets)
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Formulary
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Opicapone (Ongentys® )
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Formulary
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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
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| 04.09.01 |
Amantadine |
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Amantadine Hydrochloride
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Formulary
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Capsules
Syrup - for patients with swallowing difficulties
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| 04.09.01 |
Mild to moderate dementia in Parkinsons disease |
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| 04.09.02 |
Antimuscarinic drugs used in parkinsonism |
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Procyclidine
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Formulary
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Injection
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Procyclidine
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Formulary
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Tablets
SF syrup
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Trihexyphenidyl
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Formulary
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Tablets
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| 04.09.03 |
Drugs used in essential tremor, chorea, tics, and related disorders |
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Haloperidol
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Formulary
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Piracetam
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Formulary
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Tablets
Oral solution
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Primidone
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Formulary
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Propranolol
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Formulary
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Riluzole (Rilutek®)
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Formulary
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Supported by an ESCA
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ESCA: Riluzole
NICE TA20: Motor neurone disease - riluzole
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Tetrabenazine
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Formulary
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Tablets
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| 04.09.03 |
Torsion dystonias and other involuntary movements |
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| 04.09.04 |
Restless leg syndrome |
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Ropinirole
(Tablets)
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Formulary
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For use in Restless Legs, supported by an ESCA, see link below
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ESCA: Ropinerole in Restless Legs syndrome
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| Non Formulary Items |
Benzatropine
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Non Formulary
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Discontinued |
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Botulinum Toxin Type A
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Non Formulary
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Bromocriptine
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Non Formulary
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No longer recommended in Parkinson's Disease |
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Cabergoline
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Non Formulary
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No longer recommended in Parkinson's Disease |
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Levodopa
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Non Formulary
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Lisuride
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Non Formulary
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Orphenadrine
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Non Formulary
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Discontinued by manufacturer in December 2015 |
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Pergolide
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Non Formulary
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No longer recommended in Parkinson's Disease |
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Pramipexole
(modified release)
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Non Formulary
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For existing patients only. |
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Safinamide
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Non Formulary
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Tolcapone (Tasmar®)
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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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