NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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4 Central nervous system

4.2 Drugs used in psychoses and related disorders

4.2.1 Antipsychotic drugs

The initiation of antipsychotics would usually be under the guidance of a specialist who may base selection on a wide range of factors.

Preferred list
HALOPERIDOL

Prescribing Notes:

If haloperidol is not considered appropriate, other antipsychotics from the Total Formulary may be considered.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3224.htm

RISPERIDONE (TABLETS)

Prescribing Notes:

Preferred choice for adult patients <65 years of age. If risperidone is not considered appropriate, other atypical antipsychotics from the Total Formulary may be considered.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3248.htm

Total Formulary
ARIPIPRAZOLE

Restrictions: Restricted to initiation by a consultant psychiatrist with the injection being further restricted to use by consultant psychiatrists only. The treatment of moderate to severe manic episodes in bipolar 1 disorder and the prevention of a new manic episode in patients who experienced predominantly manic episodes is non-Formulary. Treatment of schizophrenia in adolescents 15 years and older is restricted to the initiation and management under the supervision of a child/ adolescent psychiatrist.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/128396.htm

CLOZAPINE

Restrictions: Consultant only. Patients must be registered with a Clozapine patient monitoring scheme.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3215.htm

OLANZAPINE

Restrictions: Restricted to initiation by consultant psychiatrist. The injection is restricted to use when oral therapy is not suitable. CSM have advised that there is an increased risk of stroke in elderly patients with dementia treated with olanzapine. The long-acting injection (ZypAdhera) for maintenance treatment of schizophrenia has not been accepted for use by the SMC and is non-Formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/56911.htm

CHLORPROMAZINE

Prescribing Notes:

IM chlorpromazine is not recommended for rapid tranquillisation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3210.htm

FLUPENTIXOL

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3219.htm

SULPIRIDE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3250.htm

TRIFLUOPERAZINE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3255.htm

LURASIDONE

Restrictions:

Restricted to psychiatrist initiation in accordance with local protocol as an alternative treatment option in patients in whom it is important to avoid weight gain and metabolic adverse effects.

The local protocol specifies that lurasidone be:

  • For first-line presentation psychosis only: use as a first-line treatment of schizophrenia where aripiprazole or olanzapine are not suitable
  • For adults aged 18 years and above with an establised diagnosis of schizophrenia: use as a third-line treatment option where aripiprazole has been ineffective and weight gain and metabolic adverse effects are to be minimised.

Prescribing Notes:

 

AMISULPRIDE

Restrictions: Restricted to initiation by a consultant psychiatrist.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/65573.htm

QUETIAPINE (immediate-release tablets)

Restrictions: Restricted to initiation by consultant psychiatrist and the Prescribing Notes below.

Prescribing Notes:

Immediate-release tablets are Formulary for:

  • Schizophrenia
  • Bipolar disorder:
    • Treatment of moderate to severe manic episodes in bipolar disorder.
    • Prevention of recurrence in patients with bipolar disorder, in patients whose manic episode has responded to quetiapine treatment

Indications not recommended by SMC and therefore non-Formulary are:

  • Treatment of major depressive episodes in bipolar disorder.
  • Prevention of recurrence in patients with bipolar disorder, in patients whose depressive episode has responded to quetiapine treatment.
  • Add-on treatment of major depressive episodes in patients with Major Depressive Disorder (MDD) who have had sub-optimal response to antidepressant monotherapy (applicable to MR tablets only)

Quetiapine prolonged-release preparations are not included in the GGC Adult Formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/65596.htm

4.2.2 Antipsychotic depot injections

When considering a first-line choice of long-acting injectable antipsychotic, a first-generation depot medicine should be chosen from the NHSGGC Formulary. The exception to this is where there is good evidence of effect with a specific SGA oral medication favouring its use as an LAI and where compliance, concordance, adherence or persistence with the oral medication is problematic. A second-line choice in the event of treatment failure or emergent, intolerable side-effects with the first-line choice would be an alternative first-generation depot medicine. Again, the exception to this is if there are emergent side-effects including EPSEs or Tardive Dyskinesia, where formulary SGA LAI would be considered.

Total Formulary
RISPERIDONE

Restrictions: Restricted to use under the overall supervision of a psychiatrist and subject to NHSGGC protocol.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/119707.htm

ZUCLOPENTHIXOL DECANOATE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3277.htm

ARIPIPRAZOLE (ABILIFY MAINTENA) (Long-acting injection)

Restrictions: Use for the maintenance treatment of schizophrenia in adult patients stabilised with oral aripiprazole is restricted to use under the overall supervision of a psychiatrist.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP34494-abilify-maintena.htm?q=aripiprazole&t=search&ss=text&p=6#PHP34494-abilify-maintena

FLUPENTIXOL DECANOATE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3219.htm

FLUPHENAZINE DECANOATE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3268.htm

HALOPERIDOL DECANOATE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3274.htm#_3274

PALIPERIDONE PALMITATE (injection)

Restrictions: See Prescribing Notes for further details.

Prescribing Notes:

Formulary indication:

  • The maintenance treatment of schizophrenia in adult patients stabilised with paliperidone or risperidone is restricted to use under the overall supervision of a psychiatrist. For relevant SMC advice click here

Non-Formulary indication:

  • Use of the Trevicta® brand for maintenance therapy of schizophrenia in adult patients who are clinically stable on one-monthly paliperidone palmitate injectable product.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/190009.htm

PIPOTIAZINE PALMITATE

Restrictions: Restricted to specialist initiation only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3275.htm

4.2.3 Antimanic drugs

Total Formulary
LITHIUM

Prescribing Notes:

Prescribe by brand name. Plasma concentrations should be monitored by sampling at least 12 hours after preceding dose and should be checked every 3 months in stabilised patients.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3281.htm