North East and North Cumbria Formulary


	North East and North Cumbria ICS Formulary

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Formulary Chapter 4: Central nervous system - Full Chapter

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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...

04.06

Drugs used in nausea and vertigo

Droperidol

Formulary

Granisetron

Formulary

Metoclopramide INJECTION

Formulary

Palliative care use

Nabilone

Formulary

Ondansetron INJECTION

Formulary

Palliative care use

MHRA Drug Safety Alert (Jul 2013): Ondansetron for intravenous use: dose-dependent QT interval prolongation

MHRA Drug Safety Update (Jan 2020): Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy

NICE CG84: Vomiting and diarrhoea in children under 5

NICE NG155: Tinnitus: assessment and management

04.06

Vomiting during pregnancy

04.06

Postoperative nausea and vomiting

04.06

Motion sickness

04.06

Other vestibular disorders

04.06

Cytotoxic chemotherapy

04.06

Palliative care

04.06

Migraine

04.06

Antihistamines

Cinnarizine

Formulary

Cyclizine

Formulary

Doxylamine & pyridoxine (Xonvea^®)

Formulary

Doxylamine succinate 10 mg/pyridoxine hydrochloride 10 mg tablets
- Approved for use in nausea and vomiting in pregnancy in line with RCOG guidelines.

Promethazine Hydrochloride (Phenergan)

Formulary

04.06

Phenothiazines and related drugs

Prochlorperazine

Formulary

Note: Buccastem® 3mg tablets are only approved for the treatment of nausea associated with migraine when the oral route cannot be used due to vomiting.

04.06

Domperidone and metoclopramide

Metoclopramide

Formulary

Please refer to MHRA advice

Metoclopramide: risk of neurological adverse effects

Domperidone

Unlicensed

Approved for use as a galactagogue to re-establish breastfeeding on specialist advice and following a cardiovascular risk assessment in light of MHRA advice.

MHRA Drug Safety Alert (May 2014): Domperidone: risk of cardiac side effect

MHRA Drug Safety Update (Dec 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents

04.06

5HT3 antagonists

Ondansetron

First Choice

The cheapest available formulation should be used.
Ondansetron 4mg and 8mg oro-dispersible tablets/films are approved for the treatment of post-operative nausea and vomiting in patients who do not require IV access or are nil by mouth

MHRA Drug Safety Update (Jan 2020): Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy

Palonosetron

Alternatives

Only approved for the second line treatment of chemotherapy induced nausea vomiting only.

Netupitant & Palonosetron (Akynzeo^®)

Alternatives

To be used in accordance with Northern England Strategic Clincial Cancer Network (NCCN) Guidelines

04.06

Neurokinin receptor antagonist

Aprepitant

Formulary

For the prevention of chemotherapy induced nausea and vomiting (CINV) in high risk patients in accordance with North of England Cancer Network: CINV Guidelines in adult oncology and haematology patients
Off label use in children under 12yrs / longer term use, when required, for the prevention of nausea and vomiting in paediatric patients undergoing haematopoietic stem cell transplantation (HSCT).

Chemotherapy Induced Nausea and Vomiting (CINV) Anti-emetic Guidelines

Fosaprepitant

Formulary

For the prevention of chemotherapy induced nausea and vomiting (CINV) in high risk patients in accordance with North of England Cancer Network: CINV Guidelines in adult oncology and haematology patients

Chemotherapy Induced Nausea and Vomiting (CINV) Anti-emetic Guidelines

04.06

Cannabinoid

Cannabidiol (Epidyolex^®)

Formulary

100mg/1mL oral solution
- Approved for use in combination with clobazam for treating seizuires associated with Dravet syndrome in people aged 2 years and older
- Approved for use in combination with clobazam for treating seizures associated with Lennox-Gastaut syndrome

NICE TA614: Cannabidiol with clobazam for treating seizures associated with Dravet syndrome

NICE TA615: Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome

04.06

Hyoscine

Hyoscine Hydrobromide
(tablets/patches)

Formulary

For the management of excessive secretions where tablets are unsuitable.

MHRA Drug Safety Update (July 2023): Hyoscine hydrobromide patches (Scopoderm 1.5mg Patch or Scopoderm TTS Patch): risk of anticholinergic side effects, including hyperthermia

04.06

Other drugs for Ménière's disease

Betahistine Dihydrochloride

Formulary

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	NHS England
	Homecare
	CCG

Traffic Light Status Information

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