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 Formulary Chapter 4: Central nervous system - Full Chapter
Chapter Links...
Link   MHRA Drug Safety Alert (Feb 2015): Drugs and driving: blood concentration limits set for certain drugs
Link   NENC Palliative and End of Life Care Symptom Control Guidelines
Link   NICE NG62: Cerebral palsy in under 25s: assessment and management
Link   TEWV - Medicines Optimisation – Interactive Guide
Link   TEWV Guidelines
Link   TEWV Safe Transfer of Prescribing Guidance
 Details...
04.04  Expand sub section  CNS stimulants and other drugs used for attention deficit hyperactivity disorder
Controlled Drug Methylphenidate
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Amber
  • Please prescribe by brand name
  • Approved for ADHD and the treatment of narcolepsy in adult and paediatrics.
  • Approved for improving working memory and processing speed following neurocognitive damage secondary to brain injury from; a brain tumour and its associated treatment (e.g. hydrocephalus and radiotherapy) or neurotoxic chemotherapy.
    • 5mg & 10mg tablets
    • 5mg, 10mg, 20mg, 30mg and 40mg m/r capsules (Medikinet® XL)
    • 10mg, 20mg & 30mg m/r capsules (Equasym® XL)18mg, 27mg & 36mg m/r tablets (Xaggitin® XL)
        • Existing patients who are prescribed Concerta® XL should be reviewed and switched to Xaggitin® XL as appropriate
        • Xaggitin® XL is bioequivalent to Concerta® XL
 
Link  North of Tyne, Gateshead and North Cumbria - Methylphenidate for Narcolepsy Shared Care Guidance (March 2023)
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Methylphenidate secondary to brain injury
Link  South Tyneside & Sunderland APC Shared Care Guidance - Methylphenidate, Dexamfetamine, Lisdexamfetamine and Atomoxetine for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  South Tyneside & Sunderland APC Shared Care Guidance - Methylphenidate, Dexamfetamine, Lisdexamfetamine, Atomoxetine and Guanfacine for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  TEWV ADHD prescribing algorithm in adults
Link  TEWV ADHD prescribing algorithm in Children & Young People
Link  TEWV Methylphenidate Shared Care Guideline
 
Atomoxetine
View adult BNF View SPC online View childrens BNF 		Formulary
Amber
  • 10mg, 18mg, 25mg, 40mg, 60mg, 80mg & 100mg capsules
  • 4mg/1ml oral solution - approved for patients with more complex needs e.g. younger patients and those with swallowing difficulties.

 

 
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  TEWV Atomoxetine Shared Care Guideline
 
Controlled Drug Dexamfetamine
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Amber
  • 5mg, 10mg and 20mg tablets
    • ADHD
    • Narcolepsy
    • Doses up to 60mg daily 

 

 
Link  North of Tyne, Gateshead and North Cumbria - Dexamfetamine for Narcolepsy
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  TEWV Shared Care Guidelines: Dexamfetamine
 
Controlled Drug Lisdexamfetamine
View adult BNF View SPC online View childrens BNF 		Formulary
Amber
  • 20mg, 30mg, 40mg, 50mg, 60mg & 70mg capsules
    • For third line use and specialist initiation. Should only transferred to GPs after at least three month stable symptom control
    • Approved for the treatment of ADHD in adults



 

 
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  North of Tyne, Gateshead and North Cumbria Shared Care Guideline - Attention Deficit Hyperactivity Disorder (ADHD) in Children and Young People
Link  TEWV Shared Care Guidelines: Lisdexamfetamine
 
Modafinil
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Green plus
  • Approved for:
    • treatment of patients with narcolepsy
    • treatment of idiopathic hypersomnia


 

 
Link  MHRA Drug Safety Update (Nov 2020): Modafinil (Provigil): increased risk of congenital malformations if used during pregnancy
 
Solriamfetol Black Triangle (Sunosi®)
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Red
  • 75mg and 150mg tablet
    • Approved for treating excesive daytime sleepiness caused by narcolepsy in line with NICE

 

 

 
Link  NICE TA758: Solriamfetol for treating excessive daytime sleepiness caused by narcolepsy
Link  NICE TA777: Solriamfetol for treating excessive daytime sleepiness caused by obstructive sleep apnoea (Not Recommended)
 
Pitolisant (Wakix®)
View adult BNF View SPC online View childrens BNF 		Alternatives
Red
CCG
  • Approved for use in patients with narcolepsy who experience psychomotor side effects with modafinil and dexamfetamine.
  • To be used in line with NTAG

 

 
Link  NICE TA776: Pitolisant hydrochloride for treating excessive daytime sleepiness caused by obstructive sleep apnoea (NOT RECOMMENDED BY NICE)
Link  NTAG - Treatment Appraisal Decision Summary - Pitolisant (Wakix®) for the treatment of narcolepsy with or without cataplexy in adults.
Link  NTAG - Pitolisant for Narcolepsy Treatment Pathway
 
Guanfacine (Intuniv®)
View adult BNF View SPC online View childrens BNF 		Alternatives
Amber
  • 1mg, 2mg, 3mg & 4mg prolonged release tablets
    • Approved for use in children and adolescents when 1st line stimulants and atomoxetine are contraindicated or ineffective.
    • Can also be prescribed in primary care by GPs in adults who started treatment in childhood and wish to continue, for whom stimulants are not suitable, not tolerated or have been shown to be ineffective under specialist supervision

 

 
Link  Methylphenidate, Dexamfetamine, Lisdexamfetamine and Atomoxetine for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Adults
Link  TEWV ADHD prescribing algorithm in adults
Link  TEWV Guanfacine Shared Care Guideline
 
 link Link    NICE NG87: Attention deficit hyperactivity disorder: diagnosis and management
 link Link    TEWV ADHD Prescribing Algorithm (Adults)
 link Link    TEWV ADHD Prescribing Algorithm (Children and Young People)
04.04  Expand sub section  Cocaine
 ....
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
NHSE
 NHS England
Homecare
 Homecare
CCG
 CCG

Traffic Light Status Information

Status Description

Red

 Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

 Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

 Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

 Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

 NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

 UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

 NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

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