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 Formulary Chapter 4: Central nervous system - Full Chapter
04.07  Expand sub section  Analgesics
 note 

See section 10.1.1 for non-steroidal anti-inflammatory drugs (NSAIDs)

04.07.01  Expand sub section  Non-opioid analgesics and compound analgesic preparations
Aspirin
(tablet/suppositories)
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Formulary
Green

EC tablets are not formulary

 
   
Paracetamol
(tablet/soluble tablet/liquid/suppositories)
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Formulary
Green
 
   
Paracetamol
(injection)
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Formulary
Red

Injection only if oral/rectal routes are unavailable or inappropriate

 
   
04.07.01  Expand sub section  Compound analgesic preparations
Paracetamol and codeine (Co-codamol 8/500)
(Effervescent tablet)
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Formulary
Green

Soluble preparations have a high sodium content

 
   
Paracetamol and codeine (Co-codamol 30/500)
(tablet/effervescent tablet)
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Formulary
Green

Restricted Item Effervescent tablets restricted to patients with swallowing difficulties/enteral feeding tubes.

 
   
Paracetamol and dihydrocodeine (Co-dydramol 10/500)
(tablet)
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Formulary
Green
 
Link  MHRA Drug Safety Update Jan 2018: Co-dydramol: prescribe and dispense by strength to minimise risk of medication error
   
04.07.02  Expand sub section  Opioid analgesics
Controlled Drug Alfentanil
(injection)
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Formulary
Red
 
   
Controlled Drug Buprenorphine 5-20microgram/hour weekly patch
(patch)
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Formulary
Green

Prescribe by brand name

 
   
Controlled Drug Buprenorphine 35-70microgram/hour 96hour patch
(patch)
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Formulary
Green

Prescribe by brand name

 
   
Codeine Phosphate
(tablet/liquid/suppositories/injection)
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Formulary
Green

unlicensed unlicensed suppositories

 
Controlled Drug Injection Only
   
Controlled Drug Diamorphine
(tablet/injection)
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Formulary
Green
 
   
Controlled Drug Diamorphine
(nasal spray)
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Formulary
Red

Restricted Item Paediatrics

 
   
Dihydrocodeine
(tablet/liquid/MR tablet)
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Formulary
Green
 
   
Controlled Drug Fentanyl
(patch)
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Formulary
Green

Not first line opioid choice

 
   
Controlled Drug Fentanyl (Actiq)
(lozenge)
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Formulary
Red

Restricted Item  Adult Acute Pain Team only

For painful procedures

Fentanyl lozenge with oromucosal applicator

 
   
Controlled Drug Fentanyl Nasal Spray (PecFent)
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Formulary
Amber Initiation

Restricted Item For cancer care/palliative care specialist initiation only.

Prescribe by brand name.

For the management of breakthrough pain in adult patients using opioid therapy for chronic cancer pain. Only for patients unable to tolerate, or unsuitable for treatment with, oral formulations of other opioids (e.g. morphine, oxycodone).

 

 
   
Controlled Drug Fentanyl sublingual tablets (Abstral)
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Formulary
Amber Initiation

Restricted Item For cancer care/palliative care specialist initiation only.

Prescribe by brand name.

For the management of breakthrough pain in adult patients using opioid therapy for chronic cancer pain. Only for patients unable to tolerate, or unsuitable for treatment with, oral formulations of other opioids (e.g. morphine, oxycodone).

 
   
Controlled Drug Methadone 10mg/ml
(liquid)
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Formulary
Red

Restricted Item Palliative Care only

 
   
Controlled Drug Morphine sulphate
(tablet/MR capsule/liquid/MR sachet/injection/suppositories)
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Formulary
Green

Zomorph MR cap is first line oral morphine MR product.

unlicensed unlicensed suppositories

 
   
Controlled Drug Oxycodone
(injection)
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Formulary
Amber Recommended

Restricted Item Amber for use in palliative care in the community, otherwise acute pain team only

Second line PCA

 
   
Controlled Drug Oxycodone
(liquid/capsule/MR tablet)
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Formulary
Green

In UHS, capsules and liquid are GREEN for patients who have previously been prescribed oxycodone MR due to intolerance to morphine

Capsules only for patients unable to tolerate liquid, not for ward stock

Restricted Item Liquid is RED in UHS for patients who require oral treatment after oxycodone PCA. Acute Pain Team recommendation only 

 
   
Controlled Drug Pethidine
(tablet)
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Formulary
Green
 
   
Controlled Drug Pethidine
(injection)
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Formulary
Red
 
   
Controlled Drug Tapentadol
(MR tablet/liquid)
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Formulary
Amber Recommended

Restricted Item Specialist recommendation for third or fourth line use

Liquid for breakthrough pain for patients taking MR tablets only

 
   
Controlled Drug Tramadol
(capsule/MR capsule/MR tablet)
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Formulary
Green

Not a first line option

 
   
Controlled Drug Tramadol
(injection)
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Formulary
Red

Inj only for patients who are NBM

 
   
04.07.03  Expand sub section  Neuropathic pain to top
Paracetamol
(tablet/soluble tablet/liquid/suppositories)
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First Choice
Green

First line for neuropathic pain

 
Amitriptyline
(tablet/liquid)
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Formulary
Green

For neuropathic pain in accordance with NICE Guidelines

unlicensed Off-label use

 
   
Carbamazepine
(tablet/liquid/suppositories)
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Formulary
Green
 
   
Duloxetine
(capsule)
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Formulary
Amber Recommended

For neuropathic pain in accordance with NICE Guidelines

 
   
Controlled Drug Gabapentin
(capsule)
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Formulary
Green

For neuropathic pain in accordance with NICE Guidelines

First line if pain is lancinating in nature (‘electric shocks’)

 
   
Lidocaine
(medicated plaster 5%)
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Restricted Drug Restricted

Restricted Item Restricted use.

Green for use in patients who have been treated in line with NICE CG173: Neuropathic pain, but are still experiencing pain associated with previous herpes zoster infection (post-herpetic neuralgia) (licensed indication).

Amber Initiation Amber for chronic neuropathic pain/focal neuralgia [unlicensed 'off label' use] in exceptional circumstances only (e.g. other treatment options have failed or cannot be used due to co-morbidities) in a co-operation arrangement with chronic pain or cancer care/palliative care specialist teams as per DPC Chronic Pain Prescribing Guidelines or Wessex Palliative Care Guidelines.

Red for use in rib fracture pain (see section 15.02)

 
   
Controlled Drug Pregabalin
(capsule)
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Formulary
Green

For neuropathic pain in accordance with NICE Guidelines

Also amber for epilepsy and green for generalised anxiety disorder (see section 4.8.1)

 
   
Phenytoin
(capsule/liquid)
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Formulary
Green

For trigeminal neuralgia if carbamazepine is ineffective or not tolerated

 
   
04.07.04  Expand sub section  Antimigraine drugs
04.07.04.01  Expand sub section  Treatment of the acute migraine attack
04.07.04.01  Expand sub section  Analgesics
 note 

First line option -  Paracetamol or aspirin (preferably in a soluble or dispersible form) +/- metoclopramide

Aspirin
(tablet/soluble tablet/suppositories)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Soluble or dispersible form preferred +/- metoclopramide

 
   
Paracetamol
(tablet/soluble tablet/liquid/suppositories)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Soluble or dispersible form preferred +/- metoclopramide

 
   
04.07.04.01  Expand sub section  5HT1 agonists
Sumatriptan
(tablet/injection/nasal spray)
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First Choice
Green

50mg tablet - first line oral triptan

Injection for migraine, if oral or nasal preparations fail, or cluster headache

 
Almotriptan
(tablet)
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Second Choice
Green

Second line oral triptan

 
   
Zolmitriptan
(nasal spray)
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Second Choice
Green

Useful if patients vomit

 
   
04.07.04.02  Expand sub section  Prophylaxis of migraine to top
Amitriptyline
(tablet/liquid)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Off label use

 
   
Botulinum Toxin Type A
(injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

Specify brand

 
Link  DPC Agreed Indications Botulinum Toxin (September 2013)
Link  NICE TA260: Botulinum toxin type A for the prevention of headaches in adults with chronic migraine
   
Pizotifen
(tablet)
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Formulary
Green
 
   
Propranolol
(tablet/liquid)
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Formulary
Green
 
   
Topiramate (migraine prophylaxis)
(tablet/sprinkle capsule)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
 ....
 Non Formulary Items
Buprenorphine  (Hapoctasin)
(patch)

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Non Formulary

72 hour patch non-formulary as all other formulations are 96 hourly

 
Eletriptan  (Relpax)

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Non Formulary
 
Controlled Drug  Fentanyl  (Effentora buccal tablets)

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Non Formulary
 
Flunarizine
(tabs/caps)

Non Formulary

unlicensed unlicensed

Link  NICE ESUOM33: Migraine prophylaxis: flunarizine Sept 2014
 
Frovatriptan

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Non Formulary
 
Controlled Drug  Hydromorphone  (Palladone)
(capsule/MR capsule/injection)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Methysergide  (Deseril)

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Non Formulary
 
Naratriptan  (Naramig)

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Non Formulary
 
Nefopam

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Oxycodone/Naloxone  (Targinact)
(prolonged-release tablets)

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Non Formulary
Black

Not supported for prescribing locally. Included in NHS England guidance "Items which should not be routinely prescribed in primary care".

 

 
Paracetamol and dextropropoxyphene  (Co-proxamol)

View adult BNF View SPC online View childrens BNF
Non Formulary

unlicensed unlicensed

 
Rizatriptan  (Maxalt®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tolfenamic Acid  (Clotam®)

View adult BNF View SPC online 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

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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