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 Formulary Chapter 4: Central nervous system - Full Chapter
04.02.01  Expand sub section  Antipsychotic Drugs
04.02.01  Expand sub section  First-Generation Antipsychotic Drugs
04.02.01  Expand sub section  Second-Generation Antipsychotic Drugs
Amisulpride
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Formulary
Amber 2

 Tablets 50mg, 100mg, 200mg, 400mg

 
   
Aripiprazole
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Formulary
Amber 3

Tablets 5mg, 10mg, 15mg, 30mg

 

 
Link  Aripiprazole for the treatment of schizophrenia in people aged 15 -17 years (NICE TA 213)
Link  Bipolar disorder (children) - aripiprazole (NICE TA292)
   
Clozapine (Denzapine or Clozaril)
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Formulary
Red

Tablets 25mg, 100mg

Notes:

  • For treatment-resistant schizophrenia. Initiated by consultant psychiatrist only.
  • Prescribe by brand (CNWL-MK preferred brand - Clozaril®).
  • All patients, prescribers and dispensing pharmacists must be registered with Clozaril® Patient Monitoring Service (CPMS).
  • Clozaril Patient Monitoring Service - https://www.clozaril.co.uk/scrLogon.asp (Password required)
 
Link  MHRA; Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
   
Olanzapine
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Formulary
Green
  • Tablets 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg
  • Orodispersible tablets 5mg, 10mg, 15mg, 20mg

 

Note:

  • Olanzapine has been associated with an increased risk of hyperglycaemia, diabetes mellitus and exacerbations of diabetes.
 
   
Quetiapine
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Formulary
Amber 2
  • Tablets immediate release (IR) 25mg, 100mg, 150mg, 200mg, 300mg
  • Tablets Modified Release (MR or XL) 50mg, 150mg, 200mg, 300mg, 400mg (restricted use)

Notes:

  • Quetiapine IR is the preferred option.
  • Exceptions include acutely unwell patients in whom the simplified titration and rapid dose escalation of the XL formulation (to achieve a therapeutic dose) can be used for the first three days after which the IR preparation should be used.
  • The XL formulation may be preferred if intolerable side effects develop with the IR formulation, e.g. sedation and hypotension.
 
Link  NICE Evidence summary: Quetiapine for generalised anxiety disorder
   
Risperidone
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Formulary
Amber 3
  • Tablets 500 micrograms, 1mg, 2mg, 3mg, 4mg
  • Orodispersible tablet (Quicklets®) 500 micrograms, 1mg, 2mg (restricted)
  • Liquid 1mg/1mL 
  • Risperdal Consta® Injection, Powder for reconstitution 25mg, 37.5mg, 50mg vials

Notes:

  • Only use orodispersible tablets if the patient has swallowing difficulties, to prevent “cheeking” or for patients with compliance issues.

General notes on depot injections:

  1. Anyone prescribing or administering depots must refer to the current edition of the MKCHS Depot Antipsychotic Policy.
  2. Depot antipsychotics - Comparative information and prescribing advice (Ref: The Maudsley NHS Trust Prescribing Guidelines 10th edition 2009)
  3. It is important to establish whether the patient has an allergy to sesame oil (nut allergy) or coconut oil before selecting appropriate treatment.
 
Link  MHRA: Risk of intraoperative floppy iris syndrome in people undergoing cataract surgery
   
 ....
 Non Formulary Items
Brexpiprazole  (Rexulti)

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Non Formulary
Link  Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder (NICE TA292)
 
Clozapine  (Zaponex)

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Non Formulary
Link  MHRA Drug Safety Update (October 2017)
 
Lurasidone  (Latuda)

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Non Formulary
 
Paliperidone  (Invega)
(Oral)

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Non Formulary
Link  MHRA: Risk of intraoperative floppy iris syndrome in people undergoing cataract surgery (Oct 13)
 
Sertindole  (Serdolect)

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Non Formulary
 
Ziprasidone  (Zeldox)

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Non Formulary
 
Zotepine  (Zoleptil®)

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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
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
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Routine prescribing within licensed indication  

Amber 1

Specialist recommendation followed by GP initiation and continuation  

Amber 2

Specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation   

Amber 3

Specialist initiation and stabilisation followed by GP continuation  

Amber SCG

Specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline  

Red

Hospital or specialist prescribing only  

Red Red

These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.  

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