| Formulary Chapter 4: Central nervous system - Full Chapter
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| Chapter Links... |
 Gabapentinoid (pregabalin and gabapentin):De-prescribing guidance for non-cancer pain in adults in primary care |
| 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... |
| 04.03.01 |
Tricyclic and related antidepressant drugs |
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Limited quantities of tricyclic antidepressants should be prescribed at any one time because their cardiovascular and epileptogenic effects are dangerous in overdosage.
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| 04.03.01 |
Tricyclic antidepressants |
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Amitriptyline
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Formulary
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Tablets 10mg, 25mg, 50mg
Liquid 25mg/5mL
Sugar Free oral solution 50mg/5mL
Depression.
Consider overdose risk.
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Clomipramine
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Formulary
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Capsules 10mg, 25mg, 50mg
Depressive illness, phobic and obsessional states.
MR tablets are considered by the Joint Formulary Committee for the BNF to be less suitable for prescribing.
Consider overdose risk.
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Imipramine
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Formulary
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Tablets 10mg, 25mg
Depressive illness.
Consider overdose risk.
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Lofepramine
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Formulary
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Tablets 70mg
Liquid 70mg/5mL
Depression.
Less cardiotoxicity and lower risk in overdose compared with other tricyclic antidepressants.
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Doxepin
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Formulary
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Capsules 10mg, 25mg, 50mg
Depressive illness.
Consider overdose risk.
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Nortriptyline
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Formulary
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Tablets 10mg, 25mg
Depression.
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Trimipramine (Surmontil®)
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Formulary
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Tablets 10mg, 25mg
Capsules 50mg
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 NHSE: Items which should not routinely be prescribed in primary care: policy guidance
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Dosulepin
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Formulary
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Tablets and Capsules
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LSCMMG: Guidelines for Primary Care: Review of Dosulepin
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| 04.03.01 |
Related antidepressants |
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Trazodone
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Formulary
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Capsules 50mg, 100mg
Tablets 150mg
Liquid 50mg/5mL - for titration/dose reduction and patients with swallowing difficulties.
At the 50mg and 100mg strengths capsules are significantly less expensive than tablets.
Depression, anxiety.
Consider overdose risk.
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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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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Homecare |
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ICB commissioned |
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NHS England commissioned |
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Blueteq form needed |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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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.
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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. |
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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. |
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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. |
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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). |
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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. |
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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.
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Refer to local guidance. |
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