Tablets 25mg, 50mg

Treatment of long-term insomnia

Children with learning disabilities

Children with ADHD

Children and adolescents with Autism Spectrum Disorder (ASD) and / or Smith-Magenis syndrome

Cerebral palsy

Children with complex neurodevelopmental disorders that the specialist considers eligible

Initiation of melatonin must be by a specialist in the indication being prescribed for and have a clear plan for review.

Prescribing and review of melatonin in children must follow the principles outlined in the Melatonin Pathway (Children)

For the Treatment of Rapid Eye Movement (REM) Sleep Behaviour Disorder (RBD) in Parkinson’s Disease and Lewy Body Dementia

Adults with learning disabilities

Sleep disturbance in adults with ADHD

Sleep disorders in the blind

Adults with complex neurodevelopmental disorders that the specialist considers eligible

Initiation of melatonin must be by a specialist in the indication being prescribed for and have a clear plan for review.

Prescribing and review of melatonin in adults must follow the principles outlined in the Melatonin Pathway (adults) **Under development**.

Melatonin is suitable for prescribing for the treatment of REM RBD in PD and LBD when clonazepam is not considered to be appropriate.

Primary insomnia in those over 55

Sleep problems in patients with dementia associated with Alzheimer’s

Colonis liquid 1mg/ml and 3mg tablets for all indications, including insomnia and jet lag

Tablets 10mg
Liquid 10mg/5mL

Liquid 500mg/5mL

Oral solution 500mg/mL

For narcolespsy with cataplexy under expert supervision

Capsules

Capsules 5mg, 10mg

Chlordiazepoxide is also used in a reducing regime for the management of acute alcohol withdrawal. See trust Clinical Guidelines.

Tablets 2mg, 5mg, 10mg
Liquid 2mg/5mL
Rectal tubes 2.5mg/1.25mL, 5mg/2.5mL, 10mg/2.5mL

Tablets 1mg

Tablets 10mg, 15mg

Oxazepam should be reserved for in-patient alcohol detoxification of patients with significant hepatic impairment where a short-acting benzodiazepine would be preferred. It may also be used in older patients who have been taking it long-term where a switch or discontinuation could pose a risk to the patient

LSCFT only. Consultant initiation only, primary care red for new patients.

Tablets 10mg, 25mg, 50mg, 100mg
Liquid 25mg/5mL, 100mg/5mL

 Injection

Tablets 500microgram, 1mg, 3mg

 For the treatment of schizophrenia and other psychoses

 for depression

Tablets 1.5mg, 5mg, 10mg
Capsules or tablets 500micrograms
Liquid 2mg/mL

Tablets 1mg
Liquid 1mg/5mL, 5mg/5mL

Tablets 2mg, 10mg, 25mg

Injection

Tablets 50mg, 200mg, 400mg
Liquid 100mg/mL

Tablets 5mg,10mg,15mg, 30mg
Dispersible tablets 10mg,15mg
Liquid 1mg/mL

Consultant psychiatrist initiation only

Tablets 1.5mg, 3mg, 4.5mg, 6mg

Injection

LSCFT use only

Tablets 18.5mg, 37mg, 74mg

LSCFT initiated only

Tablets 2.5mg, 5mg, 7.5mg, 10mg, 15mg
Dispersible tablets (Velotabs®) 5mg, 10mg, 15mg, 20mg

Tablets 25mg, 100mg, 150mg, 200mg, 300mg

M/R tablets 50mg, 200mg, 300mg, 400mg (to be prescribed as Sondate XL in primary care)

LSCFT initiated only

Tablets 500micrograms, 1mg, 2mg, 3mg
Dispersible tablets (Quicklets®) 1mg, 2mg
Liquid 1mg/mL

Prolonged release suspension for injection 400mg

LSCFT initiation only.

Injection 20mg/1mL, 40mg/2mL
Concentrate injection 50mg/0.5mL, 100mg/1mL

Injection 12.5mg/0.5mL, 25mg/1mL
Concentrate injection 100mg/1mL

Injection 50mg/1mL, 100mg/1mL

Pre-filled syringes 50mg, 75mg, 100mg, 150mg (Xeplion) - monthly injection

Pre-filled syringes 175mg, 263mg, 350mg, 525mg (Trevicta) - 3-monthly injection

 Pre-filled syringes 700mg, 1000mg (Byannli) - 6-monthly injection

LSCFT initiation only.

Injection 50mg/1mL, 100mg/2mL

Injection 25mg, 37.5mg, 50mg

Consultant psychiatrist initiation only
 
 

Injection 200mg/1mL
Concentrate injection 500mg/1mL

Tablets, lamotrigine 25 mg, 100 mg, 200 mg

Dispersible tablets, lamotrigine 5 mg, 25 mg, 100 mg,

Tablets 500micrograms, 2mg
Oral solution 500micrograms/5mL

 for use in all forms of epilepsy and in the treatment of mood disorders

 for the treatment of anxiety (off-label indication)

See section 4.8.1 for epilepsy indications

M/R tablets

See section 4.8.1

In November 2023, due to known significant risk of serious harm to a baby after exposure to valproate the MHRA has stipulated that new regulatory measures will be put in place in January 2024 for oral valproate medicines as follows:

• Valproate must not be initiated in patients male or female under the age of 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment and any use of valproate in women of childbearing potential should be in accordance with the Pregnancy Prevention Programme.
• At their next annual review females of childbearing potential will require the signature of a second specialist if valproate is to be continued

National Patient Safety Alert:  Valproate: organisations to prepare for new regulatory measures for oversight of prescribing to new patients and existing female patients https://assets.publishing.service.gov.uk/media/6565ddf162180b0012ce82fd/NatPSA-2023-013-MHRA.pdf

MHRA Drug Safety Update - Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met https://www.gov.uk/drug-safety-update/valproate-medicines-epilim-depakote-contraindicated-in-women-and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-prevention-programme-are-met?utm_source=eshot&utm_medium=email&utm_campaign=DSUApril2018Split2

E/C tablets 250mg, 500mg

In November 2023, due to known significant risk of serious harm to a baby after exposure to valproate the MHRA has stipulated that new regulatory measures will be put in place in January 2024 for oral valproate medicines as follows:

• Valproate must not be initiated in patients male or female under the age of 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment and any use of valproate in women of childbearing potential should be in accordance with the Pregnancy Prevention Programme.
• At their next annual review females of childbearing potential will require the signature of a second specialist if valproate is to be continued

National Patient Safety Alert:  Valproate: organisations to prepare for new regulatory measures for oversight of prescribing to new patients and existing female patients https://assets.publishing.service.gov.uk/media/6565ddf162180b0012ce82fd/NatPSA-2023-013-MHRA.pdf

MHRA Drug Safety Update - Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met https://www.gov.uk/drug-safety-update/valproate-medicines-epilim-depakote-contraindicated-in-women-and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-prevention-programme-are-met?utm_source=eshot&utm_medium=email&utm_campaign=DSUApril2018Split2

M/R tablets 400mg

M/R tablets 200mg, 400mg

Liquid 520mg/5mL

Tablets 10mg, 25mg, 50mg
Liquid 25mg/5mL

Sugar Free oral solution 50mg/5mL

capsules 25mg, 50mg

Tablets 10mg, 25mg

Use in line with LSCMMG pain guidance

Tablets and Capsules

Dosulepin may continue to be prescribed for existing patients, RAG rating Amber 0 – please refer to the guideline below.  Patients should be regularly reviewed with a view to stopping or reducing doses due to the ongoing risk of cardiovascular events and risks associated with overdose. Elderly patients are particularly susceptible to many of these side-effects.

Tablets 15mg

Tablets 150mg

Tablets 5mg, 10mg, 20mg

Tablets 50mg, 100mg

Citalopram or Sertraline are the antidepressants of choice in epilepsy

Tablets 5mg, 10mg, 20mg

Vortioxetine is recommended as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episode

Tablets 500mg

Consultant psychiatrist initiation only

with prior approval. LSCFT to approve all applications to use - patients currently on treatment can continue.

Tablets 4mg

Consultant psychiatrist initiation only

Tablets 37.5mg, 75mg
M/R capsules 75mg, 150mg

M/R capsules 225mg - to be prescribed as Vencarm XL in primary care
 
Immediate release tablets are first line

Capsules 10mg, 18mg, 25mg, 40mg, 60mg

 Restricted to initiation by child or adolescent psychiatrists or paediatricians
experienced in the management of ADHD.

Tablets 25 micrograms, 50 micrograms

**outstanding query**

Tablets 5mg, 10mg, 20mg

M/R tablets 1mg, 2mg, 3mg, 4mg

For use in children and adolescents 6 - 17 years for whom stimulants are not suitable, not tolerated or have shown to be ineffective
 

 Adult -  hard capsules 30mg, 50mg, 70mg

Under 16 years - hard capsules 20mg, 30mg, 40mg, 50mg, 60mg, 70mg
  

Tablets 5mg, 10mg, 20mg
M/R tablets 18mg, 27mg, 36mg, 54mg
M/R capsules 5mg, 10mg, 20mg, 30mg, 40mg, 50mg, 60mg

All brands are formulary - choice of brand to made by specialist

For adult patients under the care of Psychiatry UK in South Cumbria, please prescribe as Xaggatin XL in primary care

Tablets 100mg

Specialist initiation only

Tablets 75mg, 150mg

for NICE TA758:  Solriamfetol for excessive daytime sleepiness caused by narcolepsy

for NICE TA777: Solriamfetol for treating excessive daytime sleepiness caused by obstructive sleep apnoea 

6mg/ml solution for injection 3ml pre-filled pens 

liraglutide is recommended as an option in overweight and obesity as long as it is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service

 for NICE TA749 Liraglutide for managing obesity in people aged 12 to 17 years (terminated appraisal)

Solution for injection in pre filled pen

0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg

Only available via referral to a Tier 3 Weight Management Service (though not commercially available yet)

 for NICE TA910

Tablets Doxylamine succinate 10 mg, Pyridoxine hydrochloride 10 mg

Off-label use for the treatment of post-chemotherapy nausea and vomiting.

* For Oncology use only *

**under review**

75mg

 Prophylaxis of migraine (in patients who have at least 4 migraine days per month)

** North-West Pathway for Headache being developed **

Cinnarizine 20 mg, Dimenhydrinate 40 mg

Third line

**Under review**

Tablets 50mg

injection 50mg/1mL

Tablets 25mg

Tablets 25mg
Tablets 6mg 
Injection 25mg/1mL

For palliative care use only

Care in the last days or weeks of life - nausea and vomiting in the last days of life AND agitation/terminal restlessness in the last days of life 

 for schizophrenia (new patients)

Tablets 10mg
Liquid 5mg/5mL
Suppositories 30mg
 
 in paediatrics

Domperidone is now authorised for the relief of symptoms of nausea and vomiting only in adults and adolescents 12 years of age or older and weighing 35kg or more. Consider alternative treatments to domperidone in children younger than 12 years of age who need relief of symptoms of nausea and vomiting.

MHRA/CHM advice
Domperidone is associated with a small increased risk of serious ventricular arrhythmia or sudden cardiac death, especially in patients over 60 years and on doses higher than 30mg/day. The European Medicines Agency and MHRA have restricted its indications, introduced new contra-indications and reduced the maximum dose and duration of use.

Tablets 8mg
Liquid 4mg/5mL
Injection 4mg/2mL, 8mg/4mL

MHRA warning – risk of prolongation of the QT interval. Maximum single dose of ondansetron injection for the management of chemotherapy-induced nausea and vomiting in adults is 16mg.

 Inhalation vapour 3ml bottles with device (Each bottle contains 3 ml of methoxyflurane 99.9%)

Use restricted to consultants/SAS doctors/Registrars in UHMB Emergency Departments and Urgent Treatment Centre only

SEVEN day patches only to be prescribed (brands are interchangeable)

Hospital prescriber to prescribe generically and contract patches to be supplied

(To be prescribed as Sevodyne patches in Primary Care - 5,10,15 and 20mcg/hr)

Only for use in patients who are unable to take or tolerate oral medicine (including soluble tablets and liquids) OR where use of the low-dose buprenorphine patches may prevent administration problems for frail, elderly patients in the Community.

Transdermal preparations lack the flexibility required when treating patients with fluctuating or uncontrolled pain. Use should be reserved for patients with stable pain who are unable to take or tolerate oral medicines. Buprenorphine patches are several times more expensive than equivalent doses of oral analgesics, and inappropriate use of transdermal preparations has cost implications for commissioners. It is recommended that the reason for using a patch is documented on initiation and, if appropriate, patients are switched to oral formulations at the earliest opportunity.

**Under review**

s/l tablets 200micrograms

See section 4.10 for products used in opioid dependence

**under review**

Injection 5mg, 10mg, 30mg, 100mg, 500mg

**under review**

Tablets 30mg

For use only in patients who are breastfeeding or after initiation by the pain team.  For short term use only.

**under review**

Tablets 5mg
Injection 10mg/1mL

Methadone, when used as an analgesic, should be initiated by specialists in palliative care only

see section 4.10 for products used in opioid dependence

**under review**

Check local guidance

Check local guidance 

Oxycodone should be initiated by consultant physicians or specialists in palliative care only, it is indicated only for patients who do not tolerate morphine

**under review**

M/R tablets 50mg, 100mg, 150mg, 200mg, 250mg
 
 
for palliative care
 
 
 In Morecambe Bay for other indications

**under review**

Capsules 50mg
Dispersible tablets 50mg
m/r tablets 100mg, 200mg

 Injection 100mg/2mL

See section 4.8.1

Liquid 50mg/5mL

Unlicensed

For chronic pain - RED

 For palliative care only AMBER - under review

5% Medicated Plasters

Post Herpetic Neuralgia

5% Medicated Plasters

Use outside of the license of post-herpetic neuralgia for the treatment of localised neuropathic pain with predominance of allodynia and/or hyperalgesia and dysesthesias unresponsive to other neuropathic agents.

See section 4.8.1

Tablets 50mg
Nasal spray 20mg/0.1mL actuation, 2 unit-dose spray device
Injection 6mg/0.5mL, 2 x 0.5mL prefilled syringes and auto-injector

Injection 3mg/0.5ml solution for injection in pre-filled pen

Powder for solution for injection

Specialist use only

Concentrate for solution for infusion.

100mg

Pre-filled syringe 70mg, 140mg

Pre-filled pen 70mg, 140mg

Pre-filled pens/ pre-filled syringes 225mg/1.5ml solution for injection  

Solution for injection pre-filled pens  120mg/1ml

For NICE TA659: Galcanezumab for preventing migraine

Tablets 500micrograms, 1.5mg

**Under review**

See section 4.8.1

Unlicensed indication

In November 2023, due to known significant risk of serious harm to a baby after exposure to valproate the MHRA has stipulated that new regulatory measures will be put in place in January 2024 for oral valproate medicines as follows:

• Valproate must not be initiated in patients male or female under the age of 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment and any use of valproate in women of childbearing potential should be in accordance with the Pregnancy Prevention Programme.
• At their next annual review females of childbearing potential will require the signature of a second specialist if valproate is to be continued

National Patient Safety Alert:  Valproate: organisations to prepare for new regulatory measures for oversight of prescribing to new patients and existing female patients https://assets.publishing.service.gov.uk/media/6565ddf162180b0012ce82fd/NatPSA-2023-013-MHRA.pdf

MHRA Drug Safety Update - Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met https://www.gov.uk/drug-safety-update/valproate-medicines-epilim-depakote-contraindicated-in-women-and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-prevention-programme-are-met?utm_source=eshot&utm_medium=email&utm_campaign=DSUApril2018Split2

**Under review**

Tablets 25mg, 50mg, 100mg, 200mg

Topiramate is now contraindicated in pregnancy and in women of childbearing potential unless the conditions of a Pregnancy Prevention Programme are fulfilled. This follows a review by the MHRA which concluded that the use of topiramate during pregnancy is associated with significant harm to the unborn child. Harms included a higher risk of congenital malformation, low birth weight and a potential increased risk of intellectual disability, autistic spectrum disorder and attention deficit hyperactivity disorder in children of mothers taking topiramate during pregnancy.

Capsules, 25mg. 50mg, 100mg

Approved for use in patients when at least 3 prior prophylactic treatments have failed and erenumab, galcanezumab and fremanezumab are being considered 

Capsules 5mg

Specialist consultant use only

Tablets - all strengths

Oral solution

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

Oral solution

100mg/mL

Oral solution 2.2 mg/mL 

Tablets 800mg, 1200mg

Oral Solution 33% 

Tablets 100mg, 200mg, 400mg
M/R tablets (Tegretol® Retard) 200mg, 400mg
Chewable tablets (Tegretol® Chewtabs) 100mg, 200mg
Liquid 100mg/5mL
Suppositories 125mg, 250mg

Note: 125mg suppositories are approximately equivalent in therapeutic effect to 100mg tablets (plasma concentration monitoring is recommended

Category 1 - Doctors are advised to ensure that their patient is maintained on a specific manufacturer's product

Different preparations may vary in bioavailability and are therefore not interchangeable, prescriptions should include the brand name.

Tablets 800mg

Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

Tablets 150mg, 300mg
Liquid 30mg/5mL

Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

Capsules 250mg
Liquid 250mg/5mL

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

Capsules 100mg, 300mg, 400mg

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

Capsules 25mg, 50mg, 75mg, 100mg, 150mg, 300mg

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

A decision has been made and ratified by UHMB Drug & Therapeutics Committee and Morecambe Bay Area Prescribing Committee that generic pregabalin will be dispensed for all licensed and unlicensed indications

**under review**

200mg/20ml solution for infusion - vials

Tablets 50mg, 100mg, 150mg, 200mg

 Oral solution 50mg/5ml

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

Tablets 25mg 50mg, 100mg
Dispersible tablets 5mg, 25mg, 100mg

Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

CSM advice: blood disorders - see BNF

Tablets 250mg, 500mg, 1g
Liquid 100mg/mL

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

Tablets 15mg, 30mg
Liquid 15mg/5mL

  Stocked for patients admitted on this but not recommended for initiation

Category 1 - Doctors are advised to ensure that their patient is maintained on a specific manufacturer's product

Liquid 50mg/5mL (alcohol free) for paediatric use only

**under review**

Tablets 250mg

  Stocked for patients admitted on this but not recommended for initiation

Category 1 - Doctors are advised to ensure that their patient is maintained on a specific manufacturer's product

**under review**

Capsules (Flynn Pharma®) 25mg, 50mg, 100mg (as phenytoin sodium)
Liquid (Epanutin®)30mg/5mL

Category 1 - Doctors are advised to ensure that the patient is maintained on a specific manufacturer's product

Phenytoin suspension 90mg in 15mL is approximately equivalent in therapeutic effect to capsules or tablets containing phenytoin sodium 100mg

**under review**

Tablets 100mg, 200mg

Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

Consultant neurologist initiation only

Tablets 5mg, 10mg, 15mg

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

Tablets 25mg,50mg, 100mg, 200mg
Sprinkle capsules 15mg, 25mg

Topiramate oral suspension - Restricted for paediatric use only, when sprinkle capsules are unsuitable. Prescribers should be cautious when selecting the strength of suspension as multiple strengths are available.

Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

Topiramate is now contraindicated in pregnancy and in women of childbearing potential unless the conditions of a Pregnancy Prevention Programme are fulfilled. This follows a review by the MHRA which concluded that the use of topiramate during pregnancy is associated with significant harm to the unborn child. Harms included a higher risk of congenital malformation, low birth weight and a potential increased risk of intellectual disability, autistic spectrum disorder and attention deficit hyperactivity disorder in children of mothers taking topiramate during pregnancy.

Crushable tablets 100mg
e/c tablets 200mg, 500mg
Liquid 200mg/5mL

 Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

Different preparations may vary in bioavailability and are therefore not interchangeable, prescriptions should include the brand name.

Counselling: hepatic & blood disorders - see BNF

In November 2023, due to known significant risk of serious harm to a baby after exposure to valproate the MHRA has stipulated that new regulatory measures will be put in place in January 2024 for oral valproate medicines as follows:

• Valproate must not be initiated in patients male or female under the age of 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment and any use of valproate in women of childbearing potential should be in accordance with the Pregnancy Prevention Programme.
• At their next annual review females of childbearing potential will require the signature of a second specialist if valproate is to be continued

National Patient Safety Alert:  Valproate: organisations to prepare for new regulatory measures for oversight of prescribing to new patients and existing female patients https://assets.publishing.service.gov.uk/media/6565ddf162180b0012ce82fd/NatPSA-2023-013-MHRA.pdf

MHRA Drug Safety Update - Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met https://www.gov.uk/drug-safety-update/valproate-medicines-epilim-depakote-contraindicated-in-women-and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-prevention-programme-are-met?utm_source=eshot&utm_medium=email&utm_campaign=DSUApril2018Split2

**Under review**

m/r tablets 200mg, 300mg, 500mg

 Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

Different preparations may vary in bioavailability and are therefore not interchangeable, prescriptions should include the brand name.

Counselling: hepatic & blood disorders - see BNF

In November 2023, due to known significant risk of serious harm to a baby after exposure to valproate the MHRA has stipulated that new regulatory measures will be put in place in January 2024 for oral valproate medicines as follows:

• Valproate must not be initiated in patients male or female under the age of 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment and any use of valproate in women of childbearing potential should be in accordance with the Pregnancy Prevention Programme.
• At their next annual review females of childbearing potential will require the signature of a second specialist if valproate is to be continued

National Patient Safety Alert:  Valproate: organisations to prepare for new regulatory measures for oversight of prescribing to new patients and existing female patients https://assets.publishing.service.gov.uk/media/6565ddf162180b0012ce82fd/NatPSA-2023-013-MHRA.pdf

MHRA Drug Safety Update - Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met https://www.gov.uk/drug-safety-update/valproate-medicines-epilim-depakote-contraindicated-in-women-and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-prevention-programme-are-met?utm_source=eshot&utm_medium=email&utm_campaign=DSUApril2018Split2

**Under review**

Injection 400mg with 4mL water for injections

Different preparations may vary in bioavailability and are therefore not interchangeable, prescriptions should include the brand name.

Counselling: hepatic & blood disorders - see BNF

In November 2023, due to known significant risk of serious harm to a baby after exposure to valproate the MHRA has stipulated that new regulatory measures will be put in place in January 2024 for oral valproate medicines as follows:

• Valproate must not be initiated in patients male or female under the age of 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment and any use of valproate in women of childbearing potential should be in accordance with the Pregnancy Prevention Programme.
• At their next annual review females of childbearing potential will require the signature of a second specialist if valproate is to be continued

National Patient Safety Alert:  Valproate: organisations to prepare for new regulatory measures for oversight of prescribing to new patients and existing female patients https://assets.publishing.service.gov.uk/media/6565ddf162180b0012ce82fd/NatPSA-2023-013-MHRA.pdf

MHRA Drug Safety Update - Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met https://www.gov.uk/drug-safety-update/valproate-medicines-epilim-depakote-contraindicated-in-women-and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-prevention-programme-are-met?utm_source=eshot&utm_medium=email&utm_campaign=DSUApril2018Split2

**Under review**

m/r capsules 150mg, 300mg
m/r granules 50mg, 100mg, 250mg, 500mg,750mg,1g

 Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

Different preparations may vary in bioavailability and are therefore not interchangeable, prescriptions should include the brand name.

Counselling: hepatic & blood disorders - see BNF

In November 2023, due to known significant risk of serious harm to a baby after exposure to valproate the MHRA has stipulated that new regulatory measures will be put in place in January 2024 for oral valproate medicines as follows:

• Valproate must not be initiated in patients male or female under the age of 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment and any use of valproate in women of childbearing potential should be in accordance with the Pregnancy Prevention Programme.
• At their next annual review females of childbearing potential will require the signature of a second specialist if valproate is to be continued

National Patient Safety Alert:  Valproate: organisations to prepare for new regulatory measures for oversight of prescribing to new patients and existing female patients https://assets.publishing.service.gov.uk/media/6565ddf162180b0012ce82fd/NatPSA-2023-013-MHRA.pdf

MHRA Drug Safety Update - Valproate medicines (Epilim▼, Depakote▼): contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met https://www.gov.uk/drug-safety-update/valproate-medicines-epilim-depakote-contraindicated-in-women-and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-prevention-programme-are-met?utm_source=eshot&utm_medium=email&utm_campaign=DSUApril2018Split2

**Under review**

Tablets 500mg
Powder sachet 500mg

Category 3 - It is usually unecessary to ensure that patients are maintained on a specific manufacturer's product as therapeutic equivalence can be assumed

Capsules 25mg, 50mg, 100mg

Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

Tablets 10mg

Category 2 - Clinical judgement should be used when deciding whether to switch between different manufacturer's products

Tablets 12.5mg*, 25mg* (*initiation pack) 50mg, 100mg, 150mg, 200mg

Cenobamate is recommended as an option for treating focal onset seizures with or without secondary generalised seizures in adults with drug-resistant epilepsy that has not been adequately controlled with at least 2 antiseizure medicines. It is recommended only if:

Tablets f/c 2mg,4mg, 6mg, 8mg, 10mg, 12mg

Suspension 500micrograms/1mL

Category 2 - Doctors should use clinical judgement when deciding whether to switch between different manufacturer's products

Capsules 250mg, 500mg

Powder for oral suspension in sachet 250mg, 500mg

RED RAG (for all ages) for continuation of treatment of patients who have previously received the drug during childhood under the NHSE standard contract for paediatric neurosciences - neurology. Not to be newly initiated in adults

Injection (solution) 10mg/2mL
Injection (emulsion) (Diazemuls®)10mg/2mL

Oromucosal solution pre-filled oral syringes 2.5mg/0.5ml, 5mg/1ml, 7.5mg/1.5ml, 10mg/2ml

Buccal liquid 10mg/1mL

Injection 50mg/5mL

Pre-filled pen 30mg/3mL

Tablets 88micrograms, 180micrograms, 350 micrograms, 700micrograms pramipexole base (equivalent to 125micrograms, 250micrograms, 500micrograms and 1mg pramipexole salt)
m/r tablets 260 micrograms, 520 micrograms 1.05mg, 2.1mg, 3.15mg base (equivalent to 375micrograms, 750micrograms, 1.5mg, 3mg, 4.5mg salt)

Pramipexole (first line) and ropinirole (second line) are   for moderate to severe restless legs syndrome - see prescribing guideline

Tablets 250micrograms, 1mg, 2mg, 5mg
m/r tablets 2mg, 4mg, 8mg

Please prescribe Ropinirole m/r 2mg, 4mg and 8mg as the branded generic Ipinnia XL® in primary care

Pramipexole (first line) and ropinirole standard release tablets (second line) are   for moderate to severe restless legs syndrome - see prescribing guideline

Patch 2mg, 4mg, 6mg, 8mg

Capsules 62.5mg (12.5/50), 125mg (25/100), 250mg (50/200)
Dispersible tablets 62.5mg (12.5/50), 125mg(25/100)
m/r capsules 125mg (25/100)

Tablets 62.5mg (12.5/50), 110mg (10/100)
Tablets 125mg (25/100)
Tablets 250mg (50/200)
m/r tablets 125mg (25/100)
m/r tablets 250mg (50/200)

Tablets - all strengths available

Solution for infusion 240mg/ml + 12mg/ml

Oral lyophilisate 1.25mg
(for patients unable to tolerate ordinary tablets)

Tablets 1mg

Rasagiline is 2nd line in patients unable to tolerate selegiline tablets

Capsules 50mg

Tablets 100mg

Third Line

Capsules 100mg
Liquid 50mg/5mL

Injection 2mg/2mL

**Under review**

See section 2.4

Tablets 50mg

Suspension 5mg/1ml

Consultant neurologist initiation only

Tablets 25mg

Injection 100units

For existing patients

Consultant use only

Brands are not interchangeable

**under review**

NiQuitin^®Patches 7mg/24hours, 14mg/24hours, 21mg/24hours
NiQuitin^® mini lozenges 1.5mg, 4mg
Nicorette^® inhalator 15mg plus 20 cartridges

Nicorette patches^® 15mg/16 hours, 25mg/16 hours -for pregnant women only

Nicotine gum - for pregnant women only - * NOT liquorice flavour*

Tablets 333mg

SPECIALIST INITIATION

Tablets 200mg

Tablets 0.5mg, 1mg

For community prescribing only

Tablets 200micrograms

**under review**

Tablets 5mg, 10mg

m/r capsules 8mg, 16mg, 24mg
Oral liquid 4mg/1ml

Tablets 10mg
Oral drops 10mg/mL
Note: 5mg = 10 drops

Primary care prescribers may start treatment with memantine without taking advice from a specialist clinician where an AChEI is already prescribed.   as per LSCMMG guidance.

Tablets 1.5mg, 3mg, 4.5mg
Patches 4.6mg/24hours, 9.5mg/24hours, 13.3mg/24 hours
Liquid 2mg/mL