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 Formulary Chapter 4: Central nervous system - Full Chapter
04.07.03  Expand sub section  Neuropathic pain
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

 
   
 ....
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
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Link to adult BNF
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Link to children's BNF
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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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