| 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... |
| 04.09.01 |
Dopaminergic drugs used in Parkinsons disease |
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Cabergoline
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Formulary
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Foslevidopa/foscarbidopa (Produodopa®)
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Formulary
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- foslevidopa 240mg/foscarbidopa 12mg in 1ml solution for infusion
- Approved for the treatment advanced Parkinson’s with motor symptoms in adults in line with NICE and NHSE Specialised Commissioning Policy
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NICE TA934: Foslevodopa–foscarbidopa for treating advanced Parkinson’s with motor symptoms
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Levidopa/carbidopa Intestinal Gel (Duodopa®)
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Formulary
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- levidopa 20mg/carbidopa 5mg intestinal gel
- Approved for the treatment of Parkinson's disease
- Please note that only the following providers are commissioned to provide this service within North East & Yorkshire: NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST, SOUTH TEES HOSPITALS NHS FOUNDATION TRUST, THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST, and LEEDS TEACHING HOSPITALS NHS TRUST
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Pramipexole (restless legs)
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Formulary
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Safinamide
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Alternatives
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- 50mg and 100mg tablets
- Approved for use in Parkinson's Disease patients on levodopa who are having motor fluctuations affecting their quality of life as an alternative to rasagiline.
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| 04.09.01 |
Dopamine receptor agonists |
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Apomorphine
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Formulary
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- 5mg/1ml (20ml) solution for infusion for infusion pumps & 10mg/1ml (3ml) solution for injection cartridges (Dacepton®) - NEW PATIENTS
- 30mg/3ml solution for injection (APO-go®) - Patients commenced on treatment prior to July 2022 can continue on APO-go® (including 50mg/10ml solution for infusion pre-filled syringes for infusion pumps)
- Apomorphine 10mg lozenges are also approved (RVI)
 Unlicensed
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County Durham Shared Care Guidelines: Apomorphine
MHRA Drug Safety Update (April 2016): Apomorphine with domperidone: minimising risk of cardiac side effects
North of Tyne, Gateshead and North Cumbria - Apomorphine - Shared Care Guidance
South Tyneside & Sunderland APC Shared Care Guideline - Apomorphine injection or infusion for Parkinson’s disease
Tees Valley Shared Care Guidelines: Apomorphine
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Bromocriptine
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Formulary
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Pramipexole
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Formulary
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- Approved for second line use in Parkinson's disease.
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Ropinirole
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Formulary
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- Ropinirole once daily formulation is only approved for use in Parkinson’s disease patients with proven compliance.
- Approved for first line use in patients with restless legs syndrome.
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Rotigotine
(Parkinsons)
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Formulary
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- For use on the advice of specialists in the treatment of Parkinson's disease. Mainly for use in patients who have difficulty with swallowing.
- Approved for second line use in patients with restless legs syndrome.
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| 04.09.01 |
Levodopa |
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Co-Beneldopa
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Formulary
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Co-Careldopa
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Formulary
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Co-Careldopa and Entacapone
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Formulary
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| 04.09.01 |
Monoamine-oxidase-B inhibitors |
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Rasagiline
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Formulary
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Selegiline Hydrochloride
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Formulary
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| 04.09.01 |
Catachol-O-methyltransferase inhibitors |
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Entacapone
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First Choice
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Opicapone
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First Choice
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Tolcapone
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Alternatives
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| 04.09.01 |
Amantadine |
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Amantadine
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Formulary
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- For use on the advice of neurologists.
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| 04.09.01 |
Mild to moderate dementia in Parkinsons disease |
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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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