Lancashire and South Cumbria Formulary


	Lancashire and South Cumbria Formulary

Search

Formulary Chapter 4: Central nervous system - Full Chapter

Chapter Links...

LSCMMG Paracetamol – prescribing weight-adjusted paracetamol in adults in the community

LSCMMG: ADHD combined adult and child shared care guideline

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

Details...

04.07.01

Non-opioid analgesics and compound analgesic preparations

For relief of mild to moderate pain

Co-codamol

Formulary

Tablets 30/500 (codeine 30mg/paracetamol 500mg),
tablets effervescent 30/500

Compound analgesic preparations (containing opioids) should not be used routinely. Patients should be given the individual components where possible to allow titration of dose. Where these preparations are used, they should be for short term use only, for relief of moderate pain.

There will be a long-term supply shortage of co-codamol 30/500mg tablets, which is expected from February 2026 until June 2026.

Prescribing in acute pain

• Only issue up to 28 days' supply to reduce/avoid stockpiling by patients

• Consider prescribing as separate paracetamol and codeine (30mg or 15mg strengths if appropriate)

• Bulk/routine switching to other opioids (tramadol, higher dose opioids), or other co-codamol compound analgesic preparations (8/500mg, 15/500mg, soluble formulations, branded generics etc) is not recommended.

Prescribing for chronic (long-term) pain

• Identify prn/infrequent collections and take these off repeat

• Contact community pharmacies and stop all repeat dispensing of co-codamol 30/500mg tablets

• Consider moving all pain medication from repeat to acute supply and review and reduce quantities where possible

• Review patients, provide guidance to consider paracetamol alone and/or rationalising if multiple opioids are prescribed

• Outline risks of codeine prescribing but may need to be an option for some people.

• Review all weekly prescriptions

• Consider comms to care homes re; ordering and not wasting prn stock monthly (use care home team ordering resources)

Prescribing following discharge/outpatient appointments

• To reduce risk of inappropriate or unintended further prescribing do not routinely add acute medicines to the prescribing record (e.g. analgesics, laxatives, PPIs etc) unless these are expected to be continued

• If adding for information purposes use the ‘Hospital Only’ section.

More information is in the linked documents, below.

Severe shortage of co-codamol 30/500 tablets , ICB comunication

Medicine supply notification Co-codamol 30/500

LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy

MHRA: Codeine for analgesia: restricted use in children because of reports of morphine toxicity

MHRA: Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe

Paracetamol

Formulary

Tablets 500mg
Dispersible tablets 500mg
Liquid 120mg/5mL, 250mg/5mL, 1g/10mL

Suppositories

Liquid and dispersible oral preparations reserved for when patients have with swallowing difficulties.

Consider OTC purchase

Some patients may be at increased risk of experiencing toxicity at therapeutic doses, particularly those with a body-weight under 50 kg and those with risk factors for hepatotoxicity. Clinical judgement should be used to adjust the dose of oral and intravenous paracetamol in these patients.

LSCMMG Paracetamol – prescribing weight-adjusted paracetamol in adults in the community

LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy

MHRA: Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe

Paracetamol

Formulary

Intravenous infusion 1g/100mL

For short term treatment of moderate pain or fever when the oral route is not available.

MHRA: Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe

Nefopam

Formulary

Tablets 30mg

For the relief of persistent pain unresponsive to other non-opioid analgesics.

Prescribers should carefully consider whether the potential benefits outweigh the risks of adverse effects in individual patients. Prescribers should be cautious of the anticholinergic burden of nefopam, particularly in the elderly.

Treatment should be reviewed regularly and stopped if benefits are not seen in the short term.

LSCMMG: Nefopam NMR

LSCMMG Paracetamol – prescribing weight-adjusted paracetamol in adults in the community

LSCMMG: Chronic Pain Patient Resources: Managing Opioid Medication

LSCMMG: Chronic Pain Prescriber Resources

LSCMMG: Headache Management Guideline For Adults

LSCMMG: Neuropathic Pain: Primary Care Management

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

04.07.01

Compound analgesic preparations

....

Key

	Restricted Drug
	Unlicensed
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium
	Cytotoxic Drug
	Controlled Drug

	High Cost Medicine
	Cancer Drugs Fund
	Homecare
	ICB commissioned
	NHS England commissioned
	Blueteq form needed
	Low carbon footprint
	Medium carbon footprint
	High carbon footprint

Status	Description
	Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.
	Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.
	Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.
	Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.
	Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.
	Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).
	Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.
	Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.
	Refer to local guidance.