netFormulary Dorset NHS
The Dorset Formulary has been developed in associations with
NHS Dorset Clinical Commissioning Group
Dorset County Hospital NHS Foundation Trust
Dorset Healthcare University NHS Foundation Trust
Poole Hospital NHS Foundation Trust
Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
 
 Search
 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:

Chapter review date:

Chapter Links...
 Details...
04.02.01  Expand sub section  Antipsychotic Drugs
04.02.01  Expand sub section  First-Generation Antipsychotic Drugs
04.02.01  Expand sub section  Second-Generation Antipsychotic Drugs
Amisulpride
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber SCG
Hospital or specialist initiation.

In accordance with NICE CG178 recommendations for the use of atypical antipsychotic drugs for the treatment of schizophrenia and local shared care guideline.


See guidance on the use of antipsychotics in conditions other than schizophrenia (NICE CG 82). 
Link  shared care guidelines for prescribing atypical antipsychotics in adults and older persons in schizophrenia and related psychoses
   
Aripiprazole (oral) (Abilify®)
(Amber when used for schizophrenia)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber SCG

Tablets, Orodispersible tablets.

Use in accordance with NICE CG178 recommendations for the use of atypical antipsychotic drugs for the treatment of schizophrenia and local shared care guidelines.

See guidance on the use of antipsychotics in conditions other than schizophrenia (NICE CG 82)

To be initiated on specialist advice only for:
-schizophrenia.
-the treatment of moderate to severe manic episodes in Bipolar I Disorder.
-the prevention of a new manic episode in patients who experienced predominantly manic episodes and whose manic episodes responded to aripiprazole treatment.

Solution shouldn't be used routinely as is very expensive (30mg = ~£600 per month)

Option based on NICE guidance and licence.

 
Link  NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years
Link  shared care guidelines for prescribing atypical antipsychotics in adults and older persons in schizophrenia and related psychoses
   
Aripiprazole (oral) (Abilify®)
(Red when used in children with neuro-developmental disorders)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Red when used in children with neuro-developmental disorders.

Use in accordance with NICE TA292 in moderate to severe manic episodes in adolescents with bipolar 1 disorder.

 
Link  Aripiprazole in moderate to severe bipolar 1 disorder in adolescents
Link  NICE TA292: aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder
   
Clozapine tablets (Clozaril)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

To be initiated by consultant psychiatrist only. For treatment-resistant schizophrenia.
Clozaril is also indicated in psychotic disorders occurring during the course of Parkinson's disease, in cases where standard treatment has failed.


24 hour helpline number for CPMS 08457 698269.

Use in accordance with NICE recommendations for the treatment and management of psychosis and schizophrenia in adults (CG178 which replaces CG82) and local shared care guideline.

(Amber in original pilot sites.)


 
Link  Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction and paralytic ileus
Link  NICE CG178: psychosis and schizophrenia in adults, treatment and management.
   
Olanzapine (oral)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber SCG

In accordance with NICE recommendations for the use of atypical antipsychotic drugs for the treatment of schizophrenia (CG178) and local shared care guideline.
In accordance with NICE recommendations for the use of atypical antipsychotic drugs for the treatment of biolar disorder NICE CG185
To be initiated on specialist advice only for schizophrenia, mania and preventing recurrence in bipolar disorders.

DCHFT: Orodispersible tablets (Velotabs) limited to use when compliance is a problem.

 
Link  shared care guidelines for prescribing atypical antipsychotics in adults and older persons in schizophrenia and related psychoses
   
Olanzapine injection
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

UNLICENSED Can be considered as a short term treatment option for psychoses with appropriate risk management arrangements.

 
   
Quetiapine
(Standard release only)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber SCG

Hospital or specialist initiation. In accordance with NICE recommendations for the use of atypical antipsychotic drugs for the treatment of schizophrenia (CG178) and local shared care guideline. Tablet formulation.

In accordance with NICE recommendations for the use of atypical antipsychotic drugs for the treatment of bipolar disorder CG185

To be initiated on specialist advice only for:
-schizophrenia.
-treatment of mania and major depressive episodes associated with bipolar disorder.
-preventing relapse in schizophrenia and preventing recurrence in bipolar disorder in patients whose have responded to quetiapine treatment.

 
Link  In Focus Document - Quetiapine MR
Link  NICE CG178: psychosis and schizophrenia in adults treatment and management
Link  Prescribing of quetiapine MR and IR formulations
Link  shared care guidelines for prescribing atypical antipsychotics in adults and older persons in schizophrenia and related psychoses
   
Quetiapine modified release
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

N.B.Higher cost preparation

When Quetiapine is prescribed to patients under the care of the Dorset Perinatal Mental Health Service, the immediate release formulation should be used.  If this causes sedation severe enough to interfere with parenting, Quetiapine modified release can be prescribed.  The responsible prescriber in the perinatal mental health team should discontinue Quetiapine modified release before the patient is discharged or transferred to another service, if necessary replacing it with Quetiapine immediate releases or a different anti-psychotic drug.

 
Link  In Focus Document - Quetiapine MR
Link  Prescribing of quetiapine MR and IR formulations
   
Risperidone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber SCG

In accordance with NICE recommendations for the use of atypical antipsychotic drugs for the treatment of schizophrenia (CG178) and local shared care guideline. Tablet or liquid formulation.

In accordance with NICE recommendations for the use of atypical antipsychotic drugs for the treatment of bipolar disorder CG185

To be initiated on specialist advice only for:

  • schizophrenia.
  • treatment of manic episodes in bipolar disorder.
  • short term use for persistent aggression in patients with moderate to severe Alzheimer’s dementia.


Refer to local dementia guidelines. Prescribing guidance to accompany request to prescribe.

Generic risperidone remains one of the least expensive oral atypicals.

Doses above 8-10mg daily may not increase therapeutic benefit but may result in extrapyramidal side effects.

 
Link  NICE CG178: psychosis and schizophrenia in adults treatment and management
Link  Shared care guideline for risperidone in children for non-psychotic disorders
Link  shared care guidelines for prescribing atypical antipsychotics in adults and older persons in schizophrenia and related psychoses
   
Risperidone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Red when used in children with neurodevelopmental disorders (oral preparation).

Red - risperidone injection.

DCHFT: Orodispersible tablets restricted to paediatric use only. 
   
 ....
 Non Formulary Items
Clozapine  (Denzapine®, Zaponex®)

View adult BNF View childrens BNF Track Changes
Non Formulary
Link  Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction and paralytic ileus
 
Lurasidone  (Latuda®)

View adult BNF View childrens BNF Track Changes
Non Formulary
Black
Not recommended. See Commissioning statement.
 
Paliperidone modified release tablets

View adult BNF View childrens BNF Track Changes
Non Formulary
Black
Not recommended.

Paliperidone is an active metabolite of risperidone.
 
Sertindole  (Serdolect®)

View adult BNF View childrens BNF
Non Formulary
 
Ziprasidone  (Zeldox®)

View adult BNF View childrens BNF
Non Formulary
 
Zotepine  (Zoleptil®)

View adult BNF View childrens BNF
Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

May be initiated, stabilised and maintained in primary, secondary or tertiary care  

Amber

Amber drug - without shared care  

Amber SCG

Amber drug - with shared care guideline  

Red

For secondary or tertiary care initiation and long-term maintenance of prescribing  

Black

Not recommended  

netFormulary