netFormulary NHS
Nottinghamshire Area Prescribing Committee
Joint Formulary
 Search
 Formulary Chapter 4: Central nervous system - Full Chapter
04.04  Expand sub section  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
Controlled Drug Methylphenidate
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber 1

Tablet Immediate Release (Generic, Ritalin®, Medikinet®)                                     Tablet Modified Release (Delmosart®,Xaggitin XL®, Xenidate XL®, Concerta® XL)    Capsule Modified Release (Medikinet® MR, Equasym® MR)

PRESCRIBE MR FORMULATIONS BY BRAND. Different versions of MR preparations may not have the same clinical effect. IR formulations can be prescribed generically.

Preferred brand for modified release tablet in primary care is Delmosart®. See Preferred Prescribing List

 

  •  (shared care): Attention Deficit Hyperactivity Disorder (ADHD) in children of 6 years and older and in adolescents as part of a comprehensive treatment program.
  •  Patients 18 years and older, or under 6 years old.
  • Treatment with methylphenidate should only be initiated by a specialist (psychiatrist or paediatrician) with expertise in ADHD following a comprehensive assessment and diagnosis.
  • The contents of Equasym XL® capsules, and Medikinet XL® capsules can be sprinkled on a tablespoon of soft food (e.g. apple sauce or yoghurt), then swallowed immediately without chewing.
 
Atomoxetine
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Capsules, Liquid (Strattera®) 4mg/mL

  •  (shared care): Attention Deficit Hyperactivity Disorder (ADHD) in children of 6 years and older and in adolescents as part of a comprehensive treatment program.
  • : Patients over 18 years old or under 6 years old
  • Treatment with atomoxetine should only be initiated by a specialist (child and adolescent psychiatrist or paediatrician) with expertise in ADHD following a comprehensive assessment and diagnosis.
  • Liquid is restricted to patients that are unable to swallow capsules.
 
Link  ADHD Shared Care Protocol: Atomoxetine Information Sheet
Link  ADHD Shared Care Protocol: Overarching Protocol
Link  Blood Pressure and Heart Rate Monitoring in Children
Link  Chart: BP by age and height centiles
Link  COVID19: ADHD monitoring during COVID19 (Notts CCG)
Link  Link to reviews
Link  MHRA information on BP and heart rate increases (2012)
Link  Risk of psychotic or manic symptoms in children and adolescents (2009)
   
Controlled Drug Dexamfetamine
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Tablet

Attention Deficit Hyperactivity Disorder:

  •  (shared care): Attention Deficit Hyperactivity Disorder (ADHD) in children of 6 years and older and in adolescents as part of a comprehensive treatment program. Treatment with dexamfetamine should only be initiated by a specialist (child and adolescent psychiatrist or paediatrician) with expertise in ADHD following a comprehensive assessment and diagnosis.
  •  : Patients over 18 years old or under 6 years old

Substance misuse :
- Specialist use only
Treatment of Narcolepsy:
- Non-formulary awaiting submission and local guidance

Oral solution is non-formulary (grey, no formal assessment), APC Sept 14.

 
Link  ADHD Shared Care Protocol: Dexamfetamine Information Sheet
Link  ADHD Shared Care Protocol: Overarching Protocol
Link  Blood Pressure and Heart Rate Monitoring in Children
Link  COVID19: ADHD monitoring during COVID19 (Notts CCG)
   
Guanfacine (Intuniv)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Tablet
  • For use in paediatrics and adolescents in those requiring a non-stimulant. To be used second line to atomoxetine or as an alternative if atomoxetine is clinically inappropriate. 
  • Link  Link to reviews
    Link  NICE ESNM70: Attention deficit hyperactivity disorder in children and young people
       
    Modafinil
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2

    Tablet

    • Restricted for initiation by specialists for treatment of excessive sleepiness associated with narcolepsy (only licensed indication).
    • Unlicensed indications (e.g. fatigue in MS) are non-formulary and classified grey.
     
    Link  Link to reviews
    Link  MHRA: Modafinil - EMA recommends restricted use (Aug 2010)
    Link  NICE Evidence Summary: Modafinil for excessive daytime sleepiness in Parkinsons disease
    Link  NICE Evidence Summary: Modafinil for fatigue in multiple sclerosis
       
    Controlled Drug Lisdexamfetamine (Elvanse)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted

    Capsules

    Attention Deficit Hyperactivity Disorder:

    •  (shared care): Attention Deficit Hyperactivity Disorder (ADHD) in children of 6 years and older and in adolescents as part of a comprehensive treatment program. Treatment with lisdexamfetamine should only be initiated by a specialist (child and adolescent psychiatrist or paediatrician) with expertise in ADHD following a comprehensive assessment and diagnosis.
    •  : Patients over 18 years old or under 6 years old, for use within NottsHC and Community Paediatrics at SFH trust only.

    - at other organisations i.e NUH. Internal funding has not been approved. No new patients to be started.

     
    Link  ADHD Shared Care Protocol: Lisdexamfetamine Information Sheet
    Link  ADHD Shared Care Protocol: Overarching Protocol
    Link  Blood Pressure and Heart Rate Monitoring in Children
    Link  COVID19: ADHD monitoring during COVID19 (Notts CCG)
    Link  Link to reviews
       
     ....
     Non Formulary Items
    Methylphenidate Hydrochloride  (Ritalin XL)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Modified release hard capsule 10mg, 20mg, 30mg 40mg 60mg .

    •  See other formulary choices 
     
    Solriamfetol Hydrochloride Black Triangle  (Sunosi)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey

    Tablet.

    • No formal assesment 
     
      
    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
    SMC
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    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

    Grey

    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.
      

    Red

    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.
      

    Amber 1

    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.
      

    Amber 2

    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
      

    Amber 3

    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.
      

    Green

    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.   

    OTC

      

    netFormulary