| Formulary Chapter 4: Central nervous system - Full Chapter
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| Chapter Links... |
 RFL: Guidelines for Acute Pain Management in Adults |
| Details... |
| 04.07.02 |
Opioid analgesics |
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Buprenorphine patch '35', '52.5','70'
(Analgesic)
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 Restricted
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Provider notes - NMUH:
- RFL:
- Restricted to Pain team initiation
- RNOH:
- UCLH:
- WH:
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Buprenorphine patch '5', '10', '15' and '20'
(Analgesic)
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Restricted
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Buprenorphine patch ‘5’ and ‘10’ patches approved 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 (5 and 10mcg/hr patches only)
- RFL:
- RNOH:
- See restriction above (5 and 10mcg/hr patches only)
- UCLH:
- WH:
- See restriction above (5 and 10mcg/hr patches only)
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Buprenorphine sublingual tablets
(Analgesic)
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Formulary
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Provider notes
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Codeine
(Analgesia)
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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:
- RNOH:
- Initiation restricted to patient review by the Acute Pain Service
- Oral solution available as 15 mg/5mL
- UCLH:
- WH:
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Diamorphine
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Restricted
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Provider notes
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Dihydrocodeine
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Formulary
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Provider notes
- NMUH:
- RFL:
- RNOH:
- UCLH:
- WH:
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Dihydrocodeine modified release
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Formulary
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Provider notes
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Fentanyl buccal tablets
(Effentora®)
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Restricted
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Provider notes
- NMUH:
- RFL:
- Approved for the pallative care and pain management team only
- RNOH:
- Only on the recommendation of the Pain Team for inpatients intolerant to or with contraindications to morphine and oxycodone. Not to be prescribed on discharge.
- UCLH:
- WH:
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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
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Fentanyl sublingual tablets
(Abstral®)
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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:
- Approved for the palliative care and pain management team only
- RNOH:
- UCLH:
- WH:
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Hydromorphone modified release
(Palladone® SR)
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Restricted
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Provider notes - NMUH:
- Restricted to Consultant Haematologists and Consultant Oncologists use only
- RFL:
- RNOH:
- UCLH:
- WH:
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Meptazinol
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Formulary
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Provider notes
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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:
- For use in pain - restricted to pain and palliative care teams
- RFL:
- For use in pain - restricted to pain and palliative care teams
- RNOH:
- UCLH:
- WH:
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Morphine immediate release oral
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Formulary
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Provider notes - NMUH:
- RFL:
- RNOH:
- Oral solution available as 10 mg/5mL
- UCLH:
- WH:
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Morphine injection
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Formulary
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Provider notes - NMUH:
- No restriction stated
 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:
- RNOH:
- Morphine sulfate 40 mg in 1mL ampoule is an unlicensed product
- UCLH:
- WH:
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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:
- RNOH:
- UCLH:
- WH:
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Oxycodone immediate release oral
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Restricted
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Provider notes - NMUH:
- RFL:
- RNOH:
- UCLH:
- WH:
- Restricted to Palliative Care only for patients with renal impairment, and for sickle-cell patients
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Oxycodone IV
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Restricted
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Provider notes - NMUH:
- RFL:
- RNOH:
- UCLH:
- WH:
- Restricted to Palliative Care only for patients with renal impairment, and for sickle-cell patients
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Oxycodone modified release oral
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Restricted
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Provider notes - NMUH:
- RFL:
- RNOH:
- UCLH:
- WH:
- Restricted to Palliative Care only for patients with renal impairment, and for sickle-cell patients
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Pethidine
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Restricted
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Provider notes - NMUH:
- RFL:
- RNOH:
- Restricted for patients unable to tolerate morphine sulphate, oxycodone or fentanyl
- UCLH:
- WH:
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Tramadol
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Restricted
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Provider notes - NMUH:
- Restricted to haematology and pain control team only
- RFL:
- RNOH:
- UCLH:
- WH:
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Tramadol modified Release
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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:
- RNOH:
- UCLH:
- WH:
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Hydromorphone injection
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Unlicensed
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Provider notes - NMUH:
- RFL:
- RNOH:
- UCLH:
- Relief of severe pain in cancer
- WH:
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| .... |
| Non Formulary Items |
Alfentanil sublingual spray 5 mg / 5mL
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Non Formulary
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Dextromoramide
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Non Formulary
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Dipipanone
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Non Formulary
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Fentanyl buccal film
(Breakyl®)
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Non Formulary
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Fentanyl lozenges
(Actiq®)
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Non Formulary
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Fentanyl nasal spray
(PecFent®, Instanyl®)
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Non Formulary
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Hydromorphone immediate release
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Non Formulary
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Morphine + Cyclizine
(Cyclimorph®)
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Non Formulary
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Morphine suppositories
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Non Formulary
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Oxycodone + Naloxone
(Pain)
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Non Formulary
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Papaveretum
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Non Formulary
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Papaveretum + Hyoscine hydrobromide
(Injection)
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Non Formulary
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Pentazocine
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Non Formulary
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Pethidine + Promethazine
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Non Formulary
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Sufentanil
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Non Formulary
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Tapentadol
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Non Formulary
 
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Not approved for:
- Moderate to severe pain (JFC March 2013, August 2015).
- Aid weaning rotation of high dose opioids in patients with chronic non-cancer pain (JFC November 2019).
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Tramadol + Paracetamol
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Non Formulary
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Key |
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Traffic Light Status Information
| Status |
Description |
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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. |
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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.
See link for the complete NCL Red List https://www.ncl-mon.nhs.uk/wp-content/uploads/2017/08/ncl_red_list.pdf |
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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. |
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