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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 4: Central nervous system - Full Chapter
04.08.01  Expand sub section  Control of epilepsy
 note 
  • 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
  • 04.08.01  Expand sub section  Carbamazepine and Oxcarbazepine
    04.08.01  Expand sub section  Gabapentin and pregabalin
    04.08.01  Expand sub section  Levetiracetam
    04.08.01  Expand sub section  Phenobarbital and other barbiturates to top
    04.08.01  Expand sub section  Valproate
    04.08.01  Expand sub section  Benzodiazepines
    Clobazam
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2

    Tablet, Oral suspension (10mg/5ml)

    • Oral suspension (10mg/5ml) available (approx £95 for 150ml, DT May18)
    • Tablets disperse in water if needed (not licensed). See here for general advice on dispersing tablets.
    • The 5mg/5ml liquid is non-formulary (rationalised to one strength for safety reasons, APC Sept 14)
    • Clobazam is only available on the NHS for the treatment of epilepsy. FP10's should be endorsed 'SLS'.
     
    Link  FDA: Drug Safety Communication - Risk of Serious Skin Reactions (Mar13)
       
    Clonazepam
    (epilepsy/ restless legs)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2

    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.
     
    Link  SFH outpatients should be sent to SFH pharmacy for supplies of unlicensed medicines. Donít prescribe on FP10HP.
       
    04.08.01  Expand sub section  Other Drugs
     ....
    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

      

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