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 Formulary Chapter 4: Central nervous system - Full Chapter
04.03  Expand sub section  Antidepressant drugs
04.03.01  Expand sub section  Tricyclic and related antidepressant drugs
04.03.01  Expand sub section  Tricyclic antidepressants
Amitriptyline
(tablet/liquid)
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First Choice
Green

May also be used off-label for hypersalivation

 
Imipramine
(tablet)
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Second Choice
Amber Recommended

note May be considered as a potential second line alternative when amitriptyline is not suitable/not tolerated

 
   
Clomipramine
(capsule)
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Formulary
Amber Recommended
 
   
Lofepramine
(tablet/liquid)
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Formulary
Amber Recommended
 
   
04.03.01  Expand sub section  Related antidepressants
Trazodone
(capsule/liquid)
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Formulary
Amber Recommended

For agitation in older people with dementia

 
   
04.03.02  Expand sub section  Monoamine-oxidase inhibitors to top
Phenelzine (Nardil)
(tablet)
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Formulary
Amber Initiation

Restricted Item Specialist use only

 
   
04.03.03  Expand sub section  Selective serotonin re-uptake inhibitors
Citalopram
(tablet/oral drops)
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First Choice
Green

Tablets and oral drops are not dose-equivalent

 
Fluoxetine
(capsule/oral solution)
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First Choice
Green

note consider oral solution as a more cost effective alternative to 10mg capsules

 
Sertraline
(tablet)
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First Choice
Green
 
Escitalopram
(tablet)
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Alternatives
Amber Recommended

Third line on specialist advice

Oral drops (Cipralex®) are Non Formulary

 
Link  MHRA Drug Safety Update: Citalopram and escitalopram: QT interval prolongation
   
Paroxetine
(tablet/liquid)
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Alternatives
Amber Recommended
 
   
04.03.04  Expand sub section  Other antidepressant drugs
Agomelatine
(tablet)
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Formulary
Amber Recommended

Restricted Item  For use within Southern Health. Initiated or recommended by a psychiatrist.

A third line option where adverse effects of alternative antidepressants make them unacceptable to patients (sexual dysfunction and sleep disturbance)

 
   
Flupentixol
(tablet)
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Formulary
Green
 
   
Mirtazapine
(tablet/orodispersible tablet)
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Formulary
Green

Orodispersible tabs restricted to patients with swallowing difficulties

 
   
Reboxetine
(tablet)
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Formulary
Amber Recommended
 
   
Venlafaxine
(tablet/MR capsule/Mr tablet)
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Formulary
Green

A third line antidepressant

 
   
Venlafaxine XL 225mg
(high dose tablet/high dose capsule)
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Formulary
Amber Recommended

A third line antidepressant

 
   
Vortioxetine
(tablet)
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Formulary
Amber Recommended

Not a first line antidepressant.

 
Link  NICE TA367 - Vortioxetine for treating major depressive episodes
   
 ....
 Non Formulary Items
Dosulepin
(capsules/tablets)

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Non Formulary
Black

Red Triangle Not recommended nationally due to significant safety concerns (see NICE CG90)

 
Fluvoxamine
(tablets)

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Non Formulary
 
Isocarboxazid

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Non Formulary
 
Mianserin

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Non Formulary
 
Nortriptyline
(tablets)

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Non Formulary
Black

Red Triangle Not recommended for use locally.

Consider alternatives according to indication.

For neuropathic pain refer to NICE CG173

For depression refer to NICE CG90

For insomnia refer to NICE CKS

 
Tranylcypromine

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Non Formulary
 
Trimipramine
(tablets/capsules)

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Non Formulary
Black

Red Triangle Not recommended for use nationally.

Consider alternatives according to indication.

For neuropathic pain refer to NICE CG173

For depression refer to NICE CG90

For insomnia refer to NICE CKS

 
Trytophan  (Optimax®)

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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

Traffic Light Status Information

Status Description

Green

Suitable for prescribing by all in both primary and secondary care.  

Amber Recommended

Specialist recommended but suitable for continuation in primary care.  

Amber Initiation

Specialist initiated but suitable for continuation in primary care.  

Amber SCG

Specialist initiated and for continuation in primary care under a locally approved shared care guideline.  

Red

Suitable for prescribing in specialist settings (secondary care) only.   

Red Specialist Centre

Secondary care medicines to be used under specialised commissioning arrangements only.  

Blue

For primary care, either via FP10 or supplied through specialist services. These products may be stocked by hospital pharmacies only for supply to primary care units/wards or for continuing supplies for patients admitted on therapy.  

Black

Not recommended for use.  

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