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. |
 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. |
 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: ADHD combined adult and child shared care guideline
- 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