| Formulary Chapter 4: Central nervous system - Full Chapter
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Control of epilepsy |
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Monotherapy
is encouraged where possible as combination therapy can lead to
increased side effects via drug interactions and toxicity
Antiepileptic drugs show a variety of drug interactions via
hepatic enzmye induction or inhibition, many of which are unpredictable
in extent and nature
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Carbamazepine and Oxcarbazepine |
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Gabapentin and pregabalin |
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Phenobarbital and other barbiturates |
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Clonazepam
(epilepsy/ restless legs)
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Formulary
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Tablet, Oral solution - local recommended strength is 2mg/5mL (contains alcohol*)
- Tablets can be dispersed in at least 30ml of water if licensed oral solution not suitable (More Info).
- *Licensed liquid contains ethanol, but local paediatric pharmacists consider ethanol content of 2mg/5mL oral solution to be within acceptable limits for children.
- GPs may initiate for restless legs as per treatment algorithm
- Injection: discontinued by manufacturer Oct 2013. If prescribed in adults discuss possible alternatives with neurologists.
- At SFH injection still on neonatal guidelines, so unlicensed stock is being purchased from IDIS until the guidelines are reviewed.
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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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