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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
 
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 Formulary Chapter 4: Central nervous system - Full Chapter
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Chapter review date:

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04.07.02  Expand sub section  Opioid analgesics
Codeine Phosphate
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First Choice
Green

Tablets, linctus.

 

Self Care Self Care Medicine for primary care.

 
Dihydrocodeine
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Second Choice
Green
Tablets, elixir.
Short-term use only. 
   
Controlled Drug Tramadol
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Second Choice
Green
Capsules.
Short-term use only. 
Link  UKMI Q&A: risk of developing Serotonin Syndrome following concomitant use of tramadol with selective serotonin reuptake inhibitors (SSRIs)
   
Controlled Drug Morphine
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Second Choice
Green
Solution, concentrated solution, modified release tablets and capsules.
For non-cancer pain, strong opioids should be considered only when they are used as part of a programme of supported rehabilitation, with the goal of helping patients to manage pain-related disability. There is no evidence of superior clinical analgesic effect of other opioids over morphine.  
   
Controlled Drug Diamorphine
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Second Choice
Green

Injections.

24/05/2019

UKMi: From week commencing 27th May, both Accord and Wockhardt, the two manufacturers of diamorphine injection in the UK, are out of stock of diamorphine 5mg injection, with an anticipated resupply date of 5th August when Wockhardt will support the entire market until Accord is back in stock from October 2019. Although diamorphine 10mg injection is available, there is insufficient stock to support use in secondary care to deliver 5mg doses. This memo advises on alternative management options. Shortage Memo

24/05/2019 - DHSC shortage communication 

 

 
   
Controlled Drug Oxycodone (oral)
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Second Choice
Amber
Solution, concentrated solution, capsules, modified release tablets.
Pain team/palliative care initiation.

Oxycodone is included only for patients where morphine is contra-indicated or not tolerated. Available data does not provide any evidence of oxycodone's superiority to morphine.

DCHFT: Used in post-operative pain in patients with eGFR <60mL/min.

RBCH: 1st line modified release opioid for Derwent patients for in-patient use only. 
   
Controlled Drug Tapentadol sustained release
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Second Choice
Amber SCG
Modified release tablets.
For Chronic Pain.
Sustained release (not immediate release) for use as a second line opiate option where morphine has not been tolerated.

DCHFT: Consultant use only. 
Link  Shared Care Guidelines for Tapentadol SR
   
Controlled Drug Buprenorphine Patches  (Butrans®)
(Low strength)
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Formulary
Green

5mcg/hr, 10mcg/hr and 20mcg patches

Only for patients with genuine swallowing difficulties who don't require a daily morphine dose exceeding 60mg.

 
   
Controlled Drug Fentanyl matrix patches (Matrifen®)
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Formulary
Amber

Please ensure all prescribing is by brand to ensure matrix patches are issued to patients. Currently, the most cost-effective matrix patch is: Matrifen.  

Pain team/palliative care initiation, where morphine is contra-indicated or not tolerated or where there is specific need for a non-oral route. For non-cancer pain, 75mcg/hour should be the maximum dose, if ineffective other causes for lack of response should be considered. 

NB: fentanyl reservoir patches are non-formulary due to increased risk of abuse and diversion.

 
   
Dihydrocodeine Injection
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Formulary
Red
 
   
Controlled Drug Fentanyl Injection/Infusion
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Formulary
Red
Red status does not apply to palliative care settings. 
   
Controlled Drug Morphine Injection/Infusion
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Formulary
Red

There is no evidence of superior clinical analgesic effect of other opioids over morphine.

Red status does not apply for palliative care use.

 
   
Controlled Drug Oxycodone Injection/Infusion
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Formulary
Red

Red categorisation does not apply to palliative care setting.


Oxycodone is included only for patients where morphine is contra-indicated or not tolerated. Available data does not provide any evidence of oxycodone's superiority to morphine.

 
   
Controlled Drug Pethidine
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Formulary
Red
Hospital use only. 
   
Controlled Drug Tramadol Injection
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Formulary
Red
 
   
Controlled Drug Alfentanil Buccal/Nasal Spray
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Formulary
Red
unlicensedUnlicensed
RBCH: Palliative care only for in-patient use - see policy.
DCHFT: Palliative care consultant only for Joseph Weld Hospice or inpatient use only. 
Link  RBCH Guidelines for Prescribing and Administration of Alfentanil Spray
   
Controlled Drug Fentanyl sublingual tablets (Abstral® )
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Formulary
Red
For the management of breakthrough pain in adults using opioids for chronic cancer pain in the palliative care setting and where other short-acting opioids have been proved to be unsuitable.


Recivit® - this has now been withdrawn from the UK market  
Link  Commissioning Statement for Abstral
   
Controlled Drug Sufentanil citrate (Zalviso®)
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Restricted Drug Restricted
Red
RBCH only: Consultant Anaesthetist only for patients at high risk of post-op pain following hip/knee arthroplasty. Patients will be identified pre-operatively as part of service evaluation.  
   
04.07.02  Expand sub section  Weak opioids
04.07.02  Expand sub section  Strong opioids
04.07.02  Expand sub section  Breakthrough pain
04.07.02  Expand sub section  Injectable to top
04.07.02  Expand sub section  Other
 ....
 Non Formulary Items
Controlled Drug  Buprenorphine Patches  (Transtec® Hapoctasin® )
(High strength)

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Non Formulary
 
Controlled Drug  Buprenorphine Sublingual Tablets  (Temgesic®)

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Non Formulary
Black

Not recommended.

 
Controlled Drug  Dextromoramide

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Non Formulary
 
Controlled Drug  Dihydrocodeine Tartrate  (DF 118 Forte®)

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Non Formulary
 
Controlled Drug  Dihydrocodeine Tartrate  (DHC Continus®)

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Non Formulary
 
Controlled Drug  Dipipanone  (Diconal®)

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Non Formulary
Link  Safety bulletin on dipipanone and cyclizine prescribing
 
Controlled Drug  Fentanyl  (Actiq®)

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Non Formulary
 
Controlled Drug  Fentanyl  (Effentora® buccal tablets)

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Non Formulary
 
Controlled Drug  Fentanyl  (Instanyl® nasal spray)

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Non Formulary
 
Fentanyl Buccal Film  (Breakyl)

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Non Formulary
 
Controlled Drug  Fentanyl Nasal Spray  (PecFent®)

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Non Formulary
 
Controlled Drug  Fentanyl reservoir patches

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Non Formulary

Non-formulary due to increased risk of abuse and diversion.

 
Controlled Drug  Hydromorphone  (Palladone®)

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Non Formulary
 
Controlled Drug  Hydromorphone Hydrochloride  (Palladone® SR)

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Non Formulary
 
Meptazinol  (Meptid®)

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Non Formulary
 
Controlled Drug  Morphine and cyclizine  (Cyclimorph®)

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Non Formulary
 
Controlled Drug  Papaveretum

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Non Formulary
 
Controlled Drug  Pentazocine

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Non Formulary
 
Controlled Drug  Pethidine Hydrochloride and promethazine  (Pamergan® P100)

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Non Formulary
 
Controlled Drug  Targinact (Oxycodone/Naloxone)  (Targinact®)

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Non Formulary
 
Tramadol Hydrochloride and paracetamol  (Tramacet®)

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Non Formulary
 
Tramadol MR

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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  

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