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 Formulary Chapter 4: Central nervous system - Full Chapter
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04.07.02  Expand sub section  Opioid analgesics
Buprenorphine patch '35', '52.5','70'
(Analgesic)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to Pain team initiation
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Buprenorphine patch '5' and '10'
(Analgesic)
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Restricted Drug Restricted
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Only buprenorphine patch ‘5’ and ‘10’ patches are available. Restricted for patients unable to take oral opioids due to swallowing difficulties / short bowel AND requiring a lower dose transdermal opioid dose than the 12 micrograms fentanyl patch (JFC March 2015).

Provider notes

  • NMUH:
    • See restriction above
  • RFL:
    • Transtec brand restricted to pain team only.
  • RNOH:
    • See restriction above
  • UCLH:
  • WH:
    • See restriction above
 
   
Buprenorphine sublingual tablets
(Analgesic)
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
   
Codeine
(Analgesia)
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Restricted Drug Restricted
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NOTE: There is more than one monograph for codeine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Check MHRA Drug Safety Updates
  • RFL:
    • No restriction stated
  • RNOH:
    • Restricted for patients admitted on codeine, requiring further supply.
    • Oral solution available as 15 mg/5mL
  • UCLH:
  • WH:
    • No restriction stated
 
   
Diamorphine
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
   
Dihydrocodeine
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Oral elixir available as 10 mg/5mL
  • UCLH:
  • WH:
    • No restriction stated
 
   
Dihydrocodeine modified release
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Fentanyl buccal tablets (Effentora)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary 
  • RFL:
    • Approved for the pallative care and pain management team only
  • RNOH:
    • Only on the recommendation of the Pain Team for patients intolerant to or with contraindications to morphine and oxycodone.
  • UCLH:
  • WH:
    • Non-formulary
 
   
Fentanyl lozenges (Actiq)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to Pain Team use and Peri-Operative analgesia only. 
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Fentanyl patch
(Chronic pain)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
   
Fentanyl sublingual tablets (Abstral)
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Restricted Drug Restricted
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Approved for the treatment of breakthrough, chronic, cancer pain in palliative patients taking opioid agonists, who are unable to obtain relief from, or are intolerant to, oral morphine and oxycodone immediate release. Pain or Palliative Care recommendation only (JFC September 2018).

Provider notes

  • NMUH:
    • Restricted to haematology and palliative care teams only
  • RFL:
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As above
 
   
Hydromorphone modified release (Palladone SR)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to Consultant Haematologists and Consultant Oncologists use only
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Meptazinol
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Methadone
(Analgesic)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • For use in pain - restricted to pain and palliative care teams
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
   
Morphine immediate release oral
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Oral solution available as 10 mg/5mL
  • UCLH:
  • WH:
    • No restriction stated
 
   
Morphine injection
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Formulary
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Provider notes

  • NMUH:
    • No restriction stated
    • Unlicensed Morphine Sulfate 1mg in 1ml Injection (10ml vial), available from ‘special-order’ manufacturers or specialist importing companies for sedation and analgesia in paediatric patients. 
  • RFL:
    • No restriction stated
  • RNOH:
    • Unlicensed Morphine sulfate 40 mg in 1mL ampoule is an unlicensed product
  • UCLH:
  • WH:
    • No restriction stated
 
   
Morphine modified release oral
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Formulary
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Provider notes

  • NMUH:
    • Morphgesic® SR: 10mg, 30mg, 60mg and 100mg Strengths available. Morphgesic SR is equivalent to Morphine Sulphate SR Continus (MST).
    • MST Continus®: ONLY 5mg MST Continus Tablets and 20mg & 30mg MST Continus Sachets are formulary.
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
   
Morphine suppositories
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Only the 10mg suppositories are kept at the RFH
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Oxycodone immediate release oral
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Restricted to Palliative Care only for patients with renal impairment, and for sickle-cell patients
 
   
Oxycodone IV
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Restricted to Palliative Care only for patients with renal impairment, and for sickle-cell patients
 
   
Oxycodone modified release oral
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Longtec® brand available
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Restricted to Palliative Care only for patients with renal impairment, and for sickle-cell patients
 
   
Papaveretum
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Formulary

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Pethidine
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Restricted for patients unable to tolerate morphine sulphate, oxycodone or fentanyl
  • UCLH:
  • WH:
    • No restriction stated
 
   
Tramadol
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Restricted to haematology and pain control team only
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
   
Tramadol modified Release
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Twice-daily formulation restricted to haematology and pain control team only. Once-daily formulation is non-formulary. 
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
   
Hydromorphone injection
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Unlicensed Drug Unlicensed
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Relief of severe pain in cancer - intrathecal use for patients on high-dose intrathecal morphine requiring frequent hospital visits for pump refill or unable to tolerate side-effects. Under the National Neuromodulation Registry (UMC Sept 2016)
  • WH:
    • Non-formulary
 
   
Cocaine Hydrochloride Solution 10% w/v
View childrens BNF
Unlicensed Drug Unlicensed
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to opthalmology
  • RNOH:
    • Restricted Item Restricted
  • UCLH:
  • WH:
    • Non-formulary
 
   
 ....
 Non Formulary Items
Alfentanyl Sublingual Spray 5 mg in 5mL

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Non Formulary
 
Buprenorphine patch '15' and '20'
(Analgesic)

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Non Formulary
 
Dextromoramide

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Non Formulary
 
Dipipanone

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Non Formulary
 
Fentanyl Buccal Film  (Breakyl)

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Non Formulary
 
Fentanyl IV

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Non Formulary
 
Fentanyl Nasal Spray  (PecFent, Instanyl)

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Non Formulary
 
Hydromorphone immediate release

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Non Formulary
 
Morphine and cyclizine  (Cyclimorph)

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Non Formulary
 
Oxycodone + Naloxone
(Pain)

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Non Formulary
 
Papaveretum + hyoscine hydrobromide
(Injection)

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Non Formulary
 
Pentazocine

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Non Formulary
 
Pethidine + Promethazine

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Non Formulary
 
Sufentanil

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Non Formulary
 
Tapentadol

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Non Formulary
Black

Not approved for moderate to severe pain (March 2013, August 2015)

 
Tramadol + Paracetamol

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Non Formulary
 
Tramadol oral drops

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

GP - 1st

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.

  

GP - 2nd

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.

  

GP - Amber

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.

  

GP - Red

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.

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

Black

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.

  

netFormulary