| Formulary Chapter 4: Central nervous system - Full Chapter
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| Chapter Links... |
 MHRA Drug Safety Alert (Feb 2015): Drugs and driving: blood concentration limits set for certain drugs |
 NENC Palliative and End of Life Care Symptom Control Guidelines |
| NICE NG62: Cerebral palsy in under 25s: assessment and management |
| TEWV - Medicines Optimisation – Interactive Guide |
| TEWV Guidelines |
| TEWV Safe Transfer of Prescribing Guidance |
| Details... |
| 04.07.04.02 |
Prophylaxis of migraine |
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Pizotifen
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Formulary
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Metoprolol
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Formulary
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Propranolol
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Formulary
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Topiramate
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Formulary
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- MHRA Drug Safety Update (July 2022): Topiramate (Topamax): start of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities in children with prenatal exposure
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MHRA Drug Safety Update (June 2024): Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme
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Atogepant (Aquipta®)
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Formulary
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- 10mg and 60mg tablets
- Approved for preventing migraine in line with NICE:
- they have 4 or more migraine days a month
- at least 3 preventative drug treatments have failed
- First 3 months supply from secondary care with a review at 3 months. If effective, transfer to primary care with a further 1 month supply from secondary care to allow for handover.
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NICE TA973: Atogepant for preventing migraine
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Clonidine
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Formulary
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- Clonidine is not generally recommended for migraine prophylaxis; may aggravate depression/cause insomnia.
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Eptinezumab (Vyepti®)
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Formulary
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- 100mg/1ml concentrate for solution for infusion
- Approved for the prevention of chronic migraine in adults in line with NICE only if
- they have 4 or more migraine days a month
- at least 3 preventative drug treatments have failed
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NICE TA871: Eptinezumab for preventing migraine
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Erenumab (Aimovig®)
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Formulary
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- 70mg/1ml and 140mg/1ml solution for injection (pre-filled pens)
- Approved for the prevention of chronic migraine in adults in line with NICE only if
- they have 4 or more migraine days a month
- at least 3 preventative drug treatments have failed
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NICE TA682: Erenumab for preventing migraine in adults
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Fremanezumab (Ajovy®)
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Formulary
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- 225mg/1.5ml solution for injection (Pre-filled pens/syringes)
- Approved for the prevention of chronic migraine in adults in line with NICE only if
- they have 4 or more migraine days a month
- at least 3 preventative drug treatments have failed
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NICE TA764: Fremanezumab for preventing migraine
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Galcanezumab (Emgality®)
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Formulary
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- 120mg/1ml injection
- Approved for the prevention of chronic migraine in adults in line with NICE only if
- they have 4 or more migraine days a month
- at least 3 preventative drug treatments have failed
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NICE TA659: Galcanezumab for preventing migraine
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Rimegepant (Vydura®)
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Formulary
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- 75mg oral lyophilisates
- Approved for preventing migraine in line with NICE
- First 3 months supply from secondary care with a review at 3 months. If effective, transfer to primary care with a further 1 month supply from secondary care to allow for handover.
- Approved for treating migraine in line with NICE
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NICE TA906: Rimegepant for preventing migraine
NICE TA919: Rimegepant for treating migraine
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Botulinum Toxin Type A
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Formulary
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- Only approved for use in accordance with NICE guidance.
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NICE TA260: Botulinum toxin type A for the prevention of headaches in adults with chronic migraine
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Amitriptyline
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 Unlicensed
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Imipramine
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Unlicensed
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Sodium valproate
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Unlicensed
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- Note: sodium valproate 500mg & 1000mg MR granules (Episenta®) are also approved for use in those who have difficulty swallowing sodium valproate tablets. MR granules may be more convenient to use than large volumes of liquid formulations.
 Black Triangle in Females
Valproate must no longer be prescribed to women and girls of
childbearing potential unless there is no alternative and they are on the
Pregnancy Prevention Programme (PPP) 
For information relating to alerts regarding valproate, including Drug Safety Updates and links to PPP materials, please use the following link:
MHRA Drug Safety Updates (valproate)
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Valproate medicines: Pregnancy Prevention Programme materials
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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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. |
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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. |
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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. |
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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. |
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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. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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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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