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

4.10 Drugs used in substance dependence

4.10.1 Alcohol dependence

Total Formulary
ACAMPROSATE

Restrictions:

Restricted to specialist initiation only. Use should be in accordance with a historic shared care agreement.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/39075.htm

DISULFIRAM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3687.htm

NALMEFENE (SELINCRO) (TABLETS)

Prescribing Notes:

Nalmefene is licensed for the reduction of alcohol consumption in adult patients with alcohol dependence who have a high drinking risk level (DRL), without physical withdrawal symptoms and who do not require immediate detoxification.

Nalmefene should only be initiated if DRL remains high two weeks after an initial assessment and should only be prescribed as part of a full package of care including the provision of continuous psychosocial support by appropriate NHS personnel.  It should also be reviewed regularly. 

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP33532-nalmefene.htm

4.10.2 Nicotine dependence

Preferred list
NICOTINE REPLACEMENT THERAPY (NICOTINELL)

Prescribing Notes:

Nicotinell® 24-hour patches are the Nicotine replacement formulation of choice. Other Nicotinell® products (i.e. lozenge or gum) can be used alone, or in combination if dual nicotine replacement is appropriate.  If a mini lozenge is required, the first choice is Niquitin Mini®.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/73679.htm#_73679

VARENICLINE

Restrictions: Restricted to use according to local protocol.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129834.htm

Total Formulary

4.10.3 Opioid dependence

Preferred list
METHADONE (SOLUTION)

Restrictions: Excludes Eptadone®.

Prescribing Notes:

The solution strength is 1mg/ ml.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3701.htm

Total Formulary
BUPRENORPHINE (sublingual tablets)

Restrictions:

Restricted to specialist services (Alcohol and Drug directorate and Glasgow Addictions Services).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/78667.htm

LOFEXIDINE

Restrictions: Restricted to specialist services (Alcohol and Drug directorate and Glasgow Addictions Services).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3699.htm

BUPRENORPHINE AND NALOXONE (SUBOXONE)

Restrictions: Restricted to initiation by Addiction Services and GPs who have received appropriate training and authorisation from Addiction Services. It should only be used for those patients in whom methadone is not suitable and for whom the use of buprenorphine is considered appropriate.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/213815.htm