Lancashire and South Cumbria
Formulary
Formulary
4 Central nervous system
04-07-04-02 Prophylaxis of migraine
| Atogepant Aquipta® |
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Formulary
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Tablets 10mg, 60mg Reduce dose to 10 mg once daily with concurrent use of potent CYP3A4 inhibitors, OATP inhibitors, or telmisartan. Available in both primary and secondary care, the requirement to complete a Blueteq form only applies to secondary care. |
 NICE TA973: Atogepant for preventing migraine |
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| Botulinum Toxin Type A botox® |
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Formulary
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Powder for solution for injection Specialist use only |
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NICE TA260: Botulinum toxin type A for the prevention of headaches in adults with chronic migraine |
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| Eptinezumab Vyepti® |
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Formulary
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Concentrate for solution for infusion 100mg/1mL |
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NICE TA871: Eptinezumab for preventing migraine |
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| Erenumab Aimovig® |
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Formulary
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Pre-filled syringe 70mg, 140mg Pre-filled pen 70mg, 140mg |
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NICE TA682: Erenumab for preventing migraine |
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| Fremanezumab Ajovy® |
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Formulary
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Pre-filled pens/ pre-filled syringes 225mg/1.5ml solution for injection |
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NICE TA764: Fremanezumab for preventing migraine |
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| Galcanezumab Emgality® |
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Formulary
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Solution for injection pre-filled pens 120mg/1ml
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NICE TA659: Galcanezumab for preventing migraine |
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For NICE TA659: Galcanezumab for preventing migraine| Propranolol |
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Formulary
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Tablets 10mg, 40mg, 80mg Prophylaxis of migraine. |
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HSSIB: Potential under-recognised risk of harm from the use of propranolol |
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| Rimegepant Vydura |
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Formulary
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Oral lyophilisate 75mg Prophylaxis of migraine (in patients who have at least 4 migraine days per month). Not recommended:
- for concomitant use with strong inhibitors of CYP3A4
- for concomitant use with strong or moderate inducers of CYP3A4
Available in both primary and secondary care, the requirement to complete a Blueteq form only applies to secondary care.
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 LSCMMG: Rimegepant position statement NICE TA906: Rimegepant for preventing migraine NICE TA919: Rimegepant for treating migraine |
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| Topiramate | |
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Formulary
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Tablets 25mg, 50mg, 100mg, 200mg Migraine Prophylaxis.
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MHRA: Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme MHRA: Topiramate (Topamax): start of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities in children with prenatal exposure Topiramate (Topamax) - Update for Primary Care: New Pregnancy Prevention Programme |
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| Zonisamide |
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Formulary
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Capsules, 25mg. 50mg, 100mg Approved for use in patients when prior prophylactic treatments have failed and erenumab, galcanezumab and fremanezumab are being considered.
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LSCMMG: Zonisamide (ZonegranŽ) NMR MHRA: Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review MHRA: Antiepileptics: risk of suicidal thoughts and behaviour |
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Unlicensed indication.Links
- HSSIB: Potential under-recognised risk of harm from the use of propranolol
- LSCMMG: Chronic Pain Patient Resources: Managing Opioid Medication
- LSCMMG: Chronic Pain Prescriber Resources
- LSCMMG: Headache Management Guideline For Adults
- LSCMMG: Headache Management Guideline For Adults
- LSCMMG: Neuropathic Pain: Primary Care Management
- LSCMMG: Opioid reduction: best interests opioid reduction position statement
- LSCMMG: OpioId treatment: patient-prescriber opioid treatment agreement
- LSCMMG: Restless Legs Syndrome in Adults in Primary Care
- LSCMMG: Rimegepant position statement
- LSCMMG: Zonisamide (ZonegranŽ) NMR
- MHRA Drug Safety Update April 2018:Valproate medicines (Epilim, Depakote): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met
- MHRA Drug Safety Update July 2022:Topiramate (Topamax): start of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities in children with prenatal exposure
- MHRA: Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review
- MHRA: Antiepileptics: risk of suicidal thoughts and behaviour
- MHRA: serious fibrotic reactions restricted use and new monitoring requirements
- MHRA: Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme
- MHRA: Topiramate (Topamax): start of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities in children with prenatal exposure
- MHRA: Valproate use in men: as a precaution, men and their partners should use effective contraception
- NICE CG150: Headaches in over 12s: diagnosis and management
- NICE CG173: Neuropathic pain in adults: pharmacological management in non-specialist settings
- NICE CG59: Low back pain and sciatica in over 16s: assessment and management
- NICE NG180: Perioperative care in adults
- NICE NG193: Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain
- NICE TA 764: Fremanezumab for preventing migraine
- NICE TA260: Botulinum toxin type A for the prevention of headaches in adults with chronic migraine
- NICE TA260: Botulinum toxin type A for the prevention of headaches in adults with chronic migraine
- NICE TA659: Galcanezumab for preventing migraine
- NICE TA659: Galcanezumab for preventing migraine
- NICE TA682: Erenumab for preventing migraine
- NICE TA682: Erenumab for preventing migraine
- NICE TA764: Fremanezumab for preventing migraine
- NICE TA871 Eptinezumab for preventing migraine
- NICE TA871: Eptinezumab for preventing migraine
- NICE TA906: Rimegepant for preventing migraine
- NICE TA919: Rimegepant for treating migraine
- NICE TA973: Atogepant for preventing migraine
- Topiramate (Topamax) - Update for Primary Care: New Pregnancy Prevention Programme