North Central London Formulary

	North Central London
	Joint Formulary

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Formulary Chapter 4: Central nervous system - Full Chapter

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RFL: Guidelines for Acute Pain Management in Adults

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04.02.01

Antipsychotic Drugs

04.02.01

First-Generation Antipsychotic Drugs

04.02.01

Second-Generation Antipsychotic Drugs

Amisulpride

Restricted

Secondary care notes

NMUH approvals:

RFL approvals:

Restricted for initiation until after a discussion with liaison psychiatry team.

RNOH approvals

Not applicable

UCLH approvals:
WH approvals:

Restricted for initiation by a Consultant Psychiatrist only.

Aripiprazole

Restricted

Intramuscular formulation (7.5mg/1mL) is approved for the rapid control of agitation and disturbed behaviours in adult patients with schizophrenia or with manic episodes in Bipolar I Disorder when oral therapy is not appropriate and where IM haloperidol is not recommended. (JFC January 2019)

Secondary care notes

NMUH approvals:

This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary but NOT routinely stocked in pharmacy. This medicine will be ordered if use is as per local Trust Guideline or is approved by the Trust Medicines Management Committee. Contact pharmacy medicines information on ext 2417 for further information.
See links below

RFL approvals:

Restricted for initiation until after a discussion with liaison psychiatry team

RNOH approvals

Initiation with Psychiatry advice only

UCLH approvals:
WH approvals:

Restricted for initiation by a Consultant Psychiatrist only

NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years

NICE TA292: Bipolar disorder (children) - aripiprazole

Clozapine (Clozaril^®)

Restricted

Secondary care notes

NMUH approvals:

Restricted to Consultant Psychiatrist use only
Monitoring required
See links below

RFL approvals:

Restricted for initiation until after a discussion with liaison psychiatry team
If a patient is admitted on this therapy please ensure that the pharmacy mental health team are aware.
Patients being treated in the UK will be registered with CPMS (Clozaril Patient Monitoring Service)
See links below

RNOH approvals

Not applicable

UCLH approvals:
WH approvals:

Restricted for initiation by a Consultant Psychiatrist only

NCL JFC: Guidance for Pharmacy Staff Managing Clozapine For Patients Admitted to Acute Hospitals

Olanzapine
(Antipsychotic)

Restricted

Secondary care notes

NMUH approvals:

Restricted to Psychiatric department use only
Only for third line treatment of schizophrenia after using standard antipsychotics and risperidone

RFL approvals:

Restricted for initiation until after a discussion with liaison psychiatry team

RNOH approvals

UCLH approvals:
WH approvals:

Restricted for initiation by a Consultant Psychiatrist only

Quetiapine

Restricted

Secondary care notes

NMUH approvals:

Restricted to Consultant Psychiatrist use only
Second line medication

RFL approvals:

Restricted for initiation until after a discussion with liaison psychiatry team

RNOH approvals

Initiation with Psychiatry advice only

UCLH approvals:
WH approvals:

Restricted for initiation by a Consultant Psychiatrist only

Quetiapine modified release

Formulary

Secondary care notes

NMUH approvals:
- Not applicable
RFL approvals:

Not applicable

RNOH approvals

Initiation with Psychiatry advice only

UCLH approvals:
WH approvals:

Not applicable

Risperidone
(Antipsychotic)

Restricted

Secondary care notes

NMUH approvals:

Restricted to Consultant Psychiatrist use only
Second line medication

RFL approvals:

Restricted for initiation until after a discussion with liaison psychiatry team

RNOH approvals

Not applicable

UCLH approvals:
WH approvals:

Restricted for initiation by a Consultant Psychiatrist only

....

Non Formulary Items

Clozapine (Denzapine^®)

Non Formulary

NCL JFC: Guidance for Pharmacy Staff Managing Clozapine For Patients Admitted to Acute Hospitals

NMUH: Trust Therapeutic Drug Monitoring Guidelines

Clozapine (Denzapine^®)

Non Formulary

NCL JFC: Guidance for Pharmacy Staff Managing Clozapine For Patients Admitted to Acute Hospitals

NMUH: Trust Therapeutic Drug Monitoring Guidelines

Clozapine (Zaponex^®)

Non Formulary

NCL JFC: Guidance for Pharmacy Staff Managing Clozapine For Patients Admitted to Acute Hospitals

NMUH: Trust Therapeutic Drug Monitoring Guidelines

Loxapine inhalation

Non Formulary

NICE TA286 (not recommended): Loxapine inhalation for treating acute agitation and disturbed behaviours associated with schizophrenia and bipolar disorder (terminated appraisal)

Lurasidone

Non Formulary

Not approved for schizophrenia (June 2015)

Paliperidone

Non Formulary

Sertindole (Serdolect^®)

Non Formulary

Ziprasidone (Zeldox^®)

Non Formulary

Zotepine (Zoleptil^®)

Non Formulary

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Medicines suitable for first-line use within primary care. Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.
	Medicines suitable for second-line use within primary care. Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.
	Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised. Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC. Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.
	Medicines which should normally be prescribed by specialists only (hospital only). For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
	Medicines on hospital formularies which have not been reviewed for suitability in primary care.
	Medicines not recommended for routine use in primary or secondary care. Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.