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 Formulary Chapter 4: Central nervous system - Full Chapter
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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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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Green

unlicensed unlicensed suppositories

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

Restricted Item Paediatrics

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

 
   
 ....
 Non Formulary Items
Buprenorphine  (Hapoctasin)
(patch)

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Non Formulary

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

 
Controlled Drug  Fentanyl  (Effentora buccal tablets)

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

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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".

 

 
  
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
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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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