| Formulary Chapter 4: Central nervous system - Full Chapter
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Management of acute anxiety generally involves the use of a benzodiazepine. For chronic anxiety (of longer than 4 weeks duration) it may be appropriate to use antidepressants.
Acute anxiety state
Treatment with benzodiazepines should be limited to the use of the lowest possible dose for the shortest possible time
Beta blockers (propranolol) may be helpful in reducing palpitations and tremor in patients who suffer with predominantly somatic symptoms of anxiety |
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Diazepam
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Formulary
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Tablet, Oral suspension or solution 2mg/5ml, Injection 10mg/2ml, Rectal tube
- Note: Diazepam injection comes in two forms - solution (IM or IV) and emulsion Diazemuls® (IV only). Emulsion is preferred for IV as it is less irritant to the veins.
Rectal tube, injection:
- Convulsions or agitation related to overdose / poisoning
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Lorazepam
(anxiety)
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Formulary
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Tablet, oral solution (see below), Injection.
- Supply problem with injection Nov 2020: SFH see alternative options compilation table.
- Tablets dissolve under the tongue if the patient has a sufficiently moist mouth (ref. NEWT Guide to enteral feeding and swallowing difficulties). Licensed oral solution (1mg/1mL) available if absolutely necessary, but is expensive (>£100 for 150ml), expires 3 months after first opening.
- Tablets disperse in water if needed. See here for general advice on dispersing tablets.
- The generic tablets manufactured by Genus are preferred if sublingual administration or doses of 500 micrograms are required (tablets are scored), but other manufacturers also produce scored tablets.
- Store injection in fridge.
- Dilute Ativan® UK brand with an equal volume of WFI or 0.9% NaCl before i.m. injection. Hospira and Baxter brands (unlicensed imports from US) should NOT be diluted before IM administration - see individual box leaflets.
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Key |
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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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CCG |
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Traffic Light Status Information
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Description |
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Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
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Medicines which should normally be prescribed by specialists only. eg hospital only.
For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
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Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
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 Nottinghamshire APC.
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Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
*Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
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Primary care/ non specialist may initiate as per APC guideline.
The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
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Medicines suitable for routine 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. |
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