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Southampton Joint Formulary
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 Formulary Chapter 4: Central nervous system - Full Chapter
04.09  Expand sub section  Drugs used in parkinsonism and related disorders
04.09.01  Expand sub section  Dopaminergic drugs used in Parkinsons disease
04.09.01  Expand sub section  Dopamine receptor agonists
Apomorphine
(injection)
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Red
High Cost Medicine

Consultant initiated in severe disease

 
   
Bromocriptine
(tablet/capsule)
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Amber Recommended

Not a first line option in Parkinson’s disease

 
   
Cabergoline
(tablet)
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Amber Recommended

Not a first line option in Parkinson’s disease

 
   
Pergolide
(tablet)
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Blue
 
   
Pramipexole
(tablet)
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Amber Recommended

Check base/salt equivalence

 
   
Ropinirole
(tablet/modified release tablet)
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Amber Recommended

An initial choice, particularly in younger patients.

 
   
Rotigotine
(patch)
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Amber Recommended

Initiated/recommended by specialists only.

A replacement for oral dopamine agonists in patients with inadequate control of nocturnal/early morning symptoms.

In patients with inadequate compliance of complex regimens (cognitive problems, unable to swallow oral medication, motor problems).

As sole treatment in emergency situations when patients are unable to swallow oral drugs

 
   
04.09.01  Expand sub section  Levodopa
Co-Beneldopa
(capsule/dispersible tablet/MR capsule)
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Amber Recommended
 
   
Co-Careldopa
(tablet/MR tablet)
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Amber Recommended
 
   
Co-Careldopa with Entacapone
(tablet)
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Amber Recommended
 
   
Co-Careldopa (Duodopa®)
(gel cassette)
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Red Specialist Centre
High Cost Medicine

Restricted Item For use as per specialist commissioning criteria set by NHS England

 
   
04.09.01  Expand sub section  Monoamine-oxidase-B inhibitors to top
Rasagiline
(tablet)
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First Choice
Amber Recommended

First choice MAO-B inhibitor

 
Selegiline Hydrochloride
(tablet/liquid)
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Amber Recommended
 
   
Safinamide
(tablets)
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Restricted Drug Restricted
Amber Initiation

Restricted Item Restricted to use in late-stage Parkinson’s Disease and motor fluctuations where treatment with rasagiline/selegiline and entacapone has failed/not tolerated

 
Link  As per Shared Care Guidelines (Pending publication)
   
04.09.01  Expand sub section  Catachol-O-methyltransferase inhibitors
Entacapone
(tablet)
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Amber Recommended

Can be used with levodopa preparations to reduce “off-time” in later Parkinson’s disease

 
   
Opicapone (Ongentys®)
(capsule)
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Amber Recommended
 
   
Tolcapone (Tasmar®)
(tablet)
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Amber Initiation

Restricted Item Specialist initiation.

Only when entacapone or opicapone are inappropriate

 
   
04.09.01  Expand sub section  Amantadine
Amantadine
(capsule)
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Amber Recommended
 
   
04.09.02  Expand sub section  Antimuscarinic drugs used in parkinsonism
Orphenadrine
(tablet/liquid)
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Amber Recommended
 
   
Procyclidine
(tablet/liquid/injection)
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Amber Recommended
 
   
Trihexyphenidyl
(tablet/liquid)
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Amber Recommended
 
   
04.09.03  Expand sub section  Drugs used in essential tremor, chorea, tics, and related disorders
Haloperidol
(tablet/liquid/injection)
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Green
 
   
Piracetam (Nootropil®)
(tablet)
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Amber Initiation

Restricted Item Specialist initiation only

For the treatment of severe myoclonic epilepsy

 
   
Tetrabenazine
(tablet)
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Green
 
   
Riluzole (Rilutek®)
(tablet/liquid)
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Amber Recommended
High Cost Medicine
 
Link  NICE TA20: Motor neurone disease - riluzole
   
04.09.03  Expand sub section  Torsion dystonias and other involuntary movements to top
Botulinum Toxin Type A
(injection)
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Red
High Cost Medicine

Specify brand and indication

Restricted Item Restricted use - discuss with directorate pharmacist

 
Link  DPC Agreed Indications Botulinum Toxin (September 2013)
   
04.09.04  Expand sub section  Restless leg syndrome
Pramipexole
(tablet)
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Formulary
Amber Initiation

Specialist use only 

Third/fourth line for restless legs syndrome

 
   
 ....
 Non Formulary Items
Benzatropine

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Non Formulary
 
Botulinum toxin type B  (NeuroBloc®)

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Non Formulary

Restricted Item May be used in exceptional circumstances if botulinum toxin type A not suitable. Discuss with directorate pharmacist.

Link  DPC Agreed Indications Botulinum Toxin (September 2013)
 
Lisuride

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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
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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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