| 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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| 04.10 |
Drugs used in substance dependence |
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Diazepam
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Formulary
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Naloxone
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Formulary
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| 04.10.01 |
Alcohol dependence |
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Acamprosate (Campral EC®)
(E/C tablets)
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Formulary
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For initiation by specialists in substance misuse
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Chlordiazepoxide
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Formulary
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Adjunct in acute alcohol withdrawal
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Diazepam
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Formulary
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Disulfiram (Antabuse®)
(Tablets)
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Formulary
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Nalmefene
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 Restricted
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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
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NICE TA325: Nalmefene for reducing alcohol consumption in people with alcohol dependence
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Naltrexone
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Formulary
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Useful as an adjunct in the treatment of alcohol dependence after a successful withdrawal
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| 04.10.02 |
Nicotine dependence |
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Nicotine replacement therapy
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First Choice
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NICE: Smoking cessation services
UKMI Q&A: What are the clinically significant drug interactions with cigarette smoking?
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Bupropion Hydrochloride (Zyban®)
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Second Choice
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NICE: Smoking cessation services
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Varenicline (Champix®)
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Second Choice
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MHRA safety update (Nov 2008)
NICE TA123: Varenicline for smoking cessation
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| 04.10.03 |
Opioid dependence |
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| 04.10.03 |
Opioid substitution therapy |
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Methadone
(Oral solution)
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Formulary
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For use under specialist addiction services
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NICE TA114: Methadone and bupreorphine for the management of opioid dependence
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Buprenorphine
(Sublingual tablets)
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Formulary
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For use under specialist addiction services
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NICE TA114: Methadone and buprenorphine for the management of opioid dependence
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Methadone
(Tablets)
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Formulary
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Methadone
(Injection)
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Formulary
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| 04.10.03 |
Adjunctive therapy and symptomatic treatment |
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Lofexidine (BritLofex®)
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Formulary
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| 04.10.03 |
Opioid-receptor antagonists |
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Naloxone
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Formulary
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Used to reverse opioid overdose
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Naltrexone (Nalorex®)
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Formulary
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On recommendation from specialist service
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NICE TA115: Drug misuse - Naltrexone for the management of opioid dependence
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| Non Formulary Items |
Buprenorphine and Naloxone (Suboxone®)
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Non Formulary
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Lofexidine Hydrochloride
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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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