BNF Chapter 4: Formulary Choices Strength and Form Comments Nervous system 4.1 Dementia
1.5mg, 3mg, 4.5mg, 6mg Capsules Specialist initiation. Patches should only be prescribed where the patient cannot Rivastigmine 4.6mg/24hrs, 9.5mg/24hrs Patch tolerate oral preparations. Where patches are required, prescribe Alzest®. Liquid 2mg/ml oral Solution sugar free should only be prescribed where capsules cannot be administered. 5mg, 10mg Tablets Specialist initiation. Orodispersible are significantly more expensive and should Donepezil Anticholinesterases 5mg, 10mg orodispersible sugar free only be prescribed where donepezil tablets cannot be administered. and NMDA receptor 8mg, 12mg Tablets Specialist initiation. Where MR capsules are required, prescribe Gazylan®. Liquid antagonists Galantamine 8mg, 16mg, 24mg MR Capsules should only be prescribed where capsules and tablets cannot be administered. 4mg/ml oral Solution sugar free 10mg, 20mg Tablets Specialist initiation. Orodispersible are significantly more expensive and should Memantine Initiation pack (7x5/10/15/20mg) only be prescribed where memantine tablets cannot be administered. 10mg, 20mg Orodispersible tablets sugar free MOPB June 2017 not recommended as regarded as low priority, poor value for money. There are no good quality data for the use of omega 3 fish oils in Omega 3 fish oils Not recommended for prescribing prevention of dementia, pre-menstrual syndrome, attention-deficit hyperactivity disorder (ADHD), atrial fibrillation, eczema, osteoarthritis or age related macular degeneration. 4.2 Epilepsy and other seizure disorders 100mg, 200mg, 400mg Tablets 100mg, 200mg ChewTablets, 1st line- Carbamazepine 100mg/5ml Solution, 200mg, 400mg MR Tablets 50mg ,100mg ,250mg ,500mg,750mg ,1G MR Grans 100mg Crusable Tablets, MHRA Toolkit on the risks of valproate medicines in female patients Feb 2016 200mg, 500mg EC Tablets, 1st line-Valproate Sodium 200mg, 300mg, 500mg MR Tablets, MHRA Valproate and developmental disorders: new alert asking for patient 200mg/5ml Syrup, review and further consideration of risk minimisation measures april 2017 200mg/5ml SF Liquid, 25mg, 50mg, 100mg, 300mg Capsules, 2nd line-Phenytoin 100mg Tablets 2nd line-Clonazepam 500microgram, 2mg Tablets Specialist Initiation 2mg, 5mg, 25mg 100mg Disp Tablets, 2nd line- Lamotrigine Specialist Initiation 25mg, 50mg, 100mg, 200mg Tablets MHRA Drug Safety 100mg, 300mg, 400mg Capsules, MHRA Drug Safety Update Oct 2017 Gabapentin (Neurontin): risk of severe 2nd line- Gabapentin Update Nov 2017 600mg, 800mg Tablets respiratory depression Antiepileptic drugs: 2nd line-Levetiracetam 250mg, 500mg, 750mg, 1G Tablets Specialist Initiation updated advice on 2nd line-Oxcarbazepine 150mg, 300mg, 600mg Tablets Specialist Initiation switching between 25mg, 50mg, 100mg, 200mg Tablets, 2nd line- Topiramate Specialist Initiation different 15mg, 25mg, 50mg Capsules manufacturers’ 15mg, 30mg Tablets, 2nd line-Phenobarbital Specialist Initiation - for epilepsy products 15mg/5ml Liquid 2nd line-Clobazam 10mg Tablets Specialist Initiation - for epilepsy 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, Pregabalin Specialist initiation 300mg Capsules Not usually recommended for prescribing in Primary Care, rare condition Stiripentol Not recommended for prescribing requiring specialised monitoring MOPB Mar 2017 In April 2017, a letter was sent reminding relevant healthcare professionals that Retigabine Discontinued all patients must be withdrawn from Trobalt by the end of June 2017. Rufinamide Not recommended for prescribing Non-formulary EPUT. Decision confirmed MOPB Nov 2016 4.2.1 Status Diazepam 5mg, 10mg Rectal Epilepticus Midazolam Prescribe by brand-Buccolam® or Epistatus® See prescribing guidelines for buccal midazolam for further details 4.3 Mental Health disorders 1st line SSRI- Sertraline 50mg, 100mg Tablets Unlicensed 20mg Capsules, 2nd line SSRI- Fluoxetine Unlicensed 20mg/5ml Liquid 20mg, 30mg Tablets, 2rd line SSRI- Paroxetine Licensed 10mg/5ml Liquid 10mg, 20mg, 40mg Tablets, 2nd line SSRI- Citalopram 40mg/ml(2mg/drop) Oral drops. NB 8 drops (16mg) Unlicensed. = 20mg Tablet 2nd line if SSRI(s) ineffective - 37.5mg Tablets, XL 75mg Tablet or Capsule Licensed. Selective norepinephrine reuptake inhibitor (SNRI). Venlafaxine Duloxetine 30mg, 60mg Capsules Licensed. SRNI 3rd line if 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg 4.3.1 Anxiety. SSRIs/SRNIsineffective/not Licensed. 300mg Capsules Generalised Anxiety tolerated - Pregabalin Disorder(GAD)in Buspirone 5mg, 10mg Tablets Licensed. Adults Clomipramine 10mg, 25mg, 50mg Capsules Unlicensed. Tricyclic (TCA) 2mg, 5mg, 10mg Tablets Diazepam Licensed for the short-term relief(2-4 weeks only) of severe/distressing anxiety 2mg/5ml, 5mg/5ml Liquid 5mg, 10mg Tablets. Escitalopram Licensed. 10mg/ml, 20mg/ml Oral drops 10mg, 25mg Tablets. Licensed. (Antihistamine) BAP (British Association for Psychopharmacology) Hydroxyzine 10mg/5ml Liquid endorses use of Hydroxyzine in the management of GAD 1mg Tablets. Lorazepam Licensed for the treatment of acute anxiety states, excitement or acute mania 4mg/ml Injection 10mg, 25mg Tablets. Promethazine Unlicensed. Antihistamine Liquid 5mg/5ml 10mg, 40mg, 80mg Tablets. Propranolol Licensed. Beta blocker 5mg/5ml, 10mg/5ml, 50mg/5ml Liquid 4.3 Mental Health disorders - cont. 1st line SSRI (based on 50mg, 100mg Tablets Licensed. acquisition cost) - Sertraline 10mg, 20mg, 40mg Tablets Citalopram Licensed. 40mg/ml(2mg/drop) Oral drops
Clomipramine 10mg, 25mg, 50mg Capsules Unlicensed. Anxiety. 5mg, 10mg Tablets Panic Disorder (PD) Escitalopram Licensed. in Adults 10mg/ml, 20mg/ml Oral drops 20mg Capsules Fluoxetine Unlicensed 20mg Disp Tablets Imipramine Tablets 10mg, 25mg. Unlicensed. 20mg, 30mg Tablets Paroxetine Licensed 10mg/5ml Liquid 20mg, 30mg Tablets 1st line - Paroxetine Licensed. Supported by NICE guidance and endorsed by BAP 10mg/5ml Liquid Licensed. Supported by NICE guidance and endorsed by BAP. The latter cites 1st line - Sertaline 50mg, 100mg Tablets Sertraline as having acute and chronic efficacy in PTSD 37.5mg Tablets, 1st line - Venlafaxine Unlicensed but endorsed by NICE and BAP XL 75mg, XL 150mg Tablet or Capsule 15mg, 30mg, 45mg Tablets Mirtazapine 15mg, 30mg, 45mg Dispersable Tablets Unlicensed but evidence cited by BAP 15mg/ml Oral Solution 10mg, 25mg, 50mg Tablets. Amitriptyline Unlicensed but evidence cited by BAP 25mg/5ml, 50mg/5ml Liquid Post-Traumatic Stress 10mg, 25mg Tablets. Disorder (PTSD) Imipramine Unlicensed but evidence cited by BAP 25mg/5ml Liquid 20mg Capsules Fluoxetine Unlicensed but evidence cited by BAP (having acute and chronic efficacy in PTSD) 20mg/5ml Liquid Olanzapine (augmentation of 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg Tablets Unlicensed but endorsed by BAP SSRI antidepressant) Tablets 5mg, 10mg, 15mg, 20mg Dispersable 0.5mg, 1mg, 2mg, 3mg, 4mg, 6mg Tablets 0.5mg, Risperidone 1mg, 2mg, 3mg, 4mg Orodispersible tablets Unlicensed but endorsed by NICE and BAP 1mg/ml Oral Solution 15mg, 30mg, 45mg Tablets Phenelzine 15mg, 30mg, 45mg Dispersable Tablets Unlicensed but evidence cited by BAP. Consultant initiation only 15mg/ml Oral Solution 5mg, 10mg, 20mg Tablets, Methylphenidate 18mg, 27mg MR Tablets, Specialist initiation. NB MR products should be prescribed by brand 5mg, 10mg, 20mg, 30mg, 40mg MR Caps Dexamphetamine 5mg Tablets Specialist initiation 4.3.2 Attention MOPB June 2017 not recommended as regarded as low priority, poor value for deficit hyperactivity money. There are no good quality data for the use of omega 3 fish oils in disorder Omega 3 fish oils Not recommended for prescribing prevention of dementia, pre-menstrual syndrome, attention-deficit hyperactivity disorder (ADHD), atrial fibrillation, eczema, osteoarthritis or age related macular degeneration. Guanfacine Not recommended for prescribing Non-formulary EPUT. Decision confirmed MOPB Nov 2016 Lithium Carbonate 200mg, 400mg MR Tablets EPUT Initiation
4.3.3 Bipolar disorder MHRA Toolkit on the risks of valproate medicines in female patients Feb 2016 and mania Valproate Semisodium 250mg, 500mg Tablets MHRA Valproate and developmental disorders: new alert asking for patient review and further consideration of risk minimisation measures april 2017 10mg, 25mg, 50mg Tablets, 4.3.4 Depression 3rd line-Amitriptyline 25mg/5ml Solution 70mg Tablets, 3rd line-Lofepramine 70mg/5ml suspension 50mg, 100mg Capsules, 3rd line-Trazodone 150mg Tablets, Tricyclic and related 50mg/5ml Solution anti-depressant drugs 10mg, 25mg, 50mg Capsules, 3rd line- Clomipramine 75mg MR Caps 3rd line-Imipramine 10mg, 25mg Tablets 3rd line-Nortriptyline 10mg, 25mg Tablets Not an EPUT formulary. SSRIs are first line for management of depression. If TCA is required, Imipramine is a more cost effective alternative. Not routinely Trimipramine Not recommended for prescribing recommended for prescribing in Primary Care, added to Red list MOPB August 2017 Doxepin 25mg, 50mg Capsules Specialist Initiation The NICE guideline on depression in adults recommends that Dosulepin should not be prescribed for adults with depression because evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose. Dosulepin has also been used ‘off label’ in 4.3.4 Depression - Dosulepin Not recommended for prescribing other indications such as fibromyalgia and neuropathic pain. However the cont. evidence for these indications is weak, and is not recommended. The lethal dose of dosulepin is relatively low and can be potentiated by alcohol and other CNS depressants. It is on EPUT formulary for consultant initiation only. Alternatives include Lofepramine, Amitriptyline, Trazodone, and Mirtazepine. Monoamine-oxidase Phenelzine 15mg Tablets Specialist initiation inhibitors Moclobamide 150mg, 300mg Tablets Specialist initiation 1st line-Sertraline 50mg, 100mg Tablets 20mg Capsules, 2nd line-Fluoxetine Selective Serotonin 20mg/5ml Liquid 10mg, 20mg,40mg Tablets Re-uptake Inhibitors 2nd line-Citalopram 40mg/ml drops 10mg, 20mg , 30mg Tablets, 2nd line-Paroxetine 10mg/5ml Susp 15mg, 30mg, 45mg Tablets, 15mg, 30mg, 45mg 2nd line- Mirtazepine Orodisp Tablets 37.5mg, 75mg Tablets, XL 75mg, XL 150mg Tablets 3rd line-Venlafaxine or Capsules 3rd line -Escitalopram 5mg, 10mg, 20mg Tablets Specialist initiation. MOPB Sept 2016
Reboxetine 4mg Tablets Specialist initiation
Duloxetine 30mg, 60mg Tablets Specialist initiation Not recommended Non formulary for EPUT as NICE TA 231 unable to recommend the use in the NHS of agomelatine for the treatment of major depressive episodes Agomelatine Not recommended for prescribing because no evidence submission was received from the manufacturer MOPB July 2020 Vortioxetine 5mg, 10mg, 20mg Tablets Specialist initiation. MOPB Sept 2016 Other Anti- Not recommended Non formulary for EPUT due to variation in potency and St. John's Wort Not recommended for prescribing depressant drugs interactions with other drugs, (an enzyme inducer) EPUT 4.3.5 Inappropriate Benperidol 250microgram Tablets Specialist initiation sexual behaviour Chlorpromazine 25mg, 50mg, 100mg Tablets
500microgram Capsules, Haloperidol 1.5mg, 5mg, 10mg Tablets, 1mg/ml, 2mg/ml Liquid 25mg Tablets, Levopromazine 25mg/ml Injection Perphenazine 2mg, 4mg Tablets Flupenthixol 3mg Tablets Specialist initiation 4.3.6 Psychoses and 2.5mg, 10mg Tablets, Pericyazine Specialist initiation schizophrenia 10mg/5ml Liquid 200mg Tablets, Sulpiride Specialist initiation 200mg/5ml Liquid Quetiapine 25mg, 100mg, 150mg, 200mg, 300mg Tablets Specialist initiation 2mg, 10mg, 25mg Tablets, Zuclopenthixol decanoate 200mg/ml Injection, decanoate Specialist initiation 500mg/ml 500microgram, 1mg, 2mg, 3mg, 4mg, 6mg Tablets, Risperidone 500microgram, 1mg, 2mg, 3mg, 4mg Orodisp Specialist initiation Tablets, 1mg/ml Liquid 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg Tablets, Olanzapine Specialist initiation 5mg, 10mg, 15mg, 20mg Orodisp Tablets
Amisulpride 50mg, 100mg, 200mg Tablets Specialist initiation 4.3.6 Psychoses and schizophrenia - cont. Aripiprazole 5mg, 10mg, 15mg, 30mg Tablets Specialist initiation EPUT Initiation-Amber for Learning Difficulties ONLY all other indications RED Restricted- Clozapine 25mg, 100mg Tablets MHRA Drug safety Update Oct 2017 Clozapine: reminder of potentially fatal risk Lurasidone Not recommended for prescribing Non-formulary EPUT. Decision confirmed MOPB Nov 2016
4.3 Mental Health disorders - cont. Flupentixol Decanoate 20mg/ml, 100mg/ml, 200mg/ml Injection Specialist initiation Risperidone 25mg, 37.5mg, 50mg Injection Specialist initiation 4.3.6 Psychoses and schizophrenia - cont. Haloperidol decanoate 50mg/ml, 100mg/ml Injection Specialist initiation
Zuclopenthixol decanoate 200mg/ml, 500mg/ml Injection Specialist initiation 4.4 Movement disorders 500microgram Capsules, 1 5mg, 5mg, 10mg Tablets 4.4.1 Dystonias and 1st line- Haloperidol . other involuntary 1mg/ml, 2mg/ml Liquid, movements 5mg/ml Injection 2nd line- Tetrabenazine 25mg Tablets 5mg Tablets, 4.4.2 Parkinson's 1st line-Procyclidine 2.5mg/5ml, 5mg/5ml Liquid, disease 10mg/2ml Injection 50mg Tablets, Antimuscarinic Drugs 2nd line-Orphenadrine 25mg/5ml, 50mg/5ml solutionn,
12.5/50, 25/100, 50/200 Capsules, 1st line-Co-Beneldopa 25/100 MR Capsules 1st line-Co-Careldopa 12.5/50, 10/100, 25/100, 25/250 Tablets 2nd line - Rasagiline 1mg tablet Specialist Initiation 5mg, 10mg Tablets, 2nd line-Selegiline Specialist Initiation 10mg/5ml Liquid 250microgram, 500microgram, 1mg, 2mg, 5mg, 2nd line- Ropinirole Specialist Initiation 10mg Tablets Specialist prescribing only, added to RED list Sept 2017 MHRA Drug Not routinely recommended for prescribing in Apomorphine Safety Update April 2016: Apomorphine with domperidone: minimising risk of primary care cardiac side effects 2nd line-Entacapone 200mg Tablets Specialist Initiation MOPB October 2019: Opicapone may only be trialled following treatment with Dopaminergic Drugs Entacapone for patients who have experienced the unacceptable adverse effect 2nd line - Opicapone 50mg capsules of persistent diarrhoea causing incontinence, or frequent passing of loose stool disturbing sleep or lifestyle, as defined by Bristol stool chart 6/7, which resolves when stopping Entacapone. 88microgram, 180microgram, 350microgram, 700microgram Tablets. Pipexus® is the cheapest 2nd line-Pramipexole Specialist Initiation prolonged released pramipexole approved MOPB Oct 2017 2nd line-Rotigotine 1mg, 2mg, 3mg, 4mg, 6mg, 8mg Patch Specialist Initiation 2nd line - Amantadine 100mg capsules Specialist Initiation Dopaminergic Drugs
Specialist Initiation 3rd line - Safinamide 50mg, 100mg tablets MOPB October 2019: Prescribe only if Amantadine not tolerated (usually due to (confusion) OR in addition to full dose Amantadine if dyskinesias.
Drugs used for Glycopyrronium bromide 1mg, 2mg Tablets Not recommended as alternative cost effective medicines available MOPB Jan 17 hypersalivation Glycopyrronium bromide Injection For use by Palliative Care Consultant only MOPB Jan 17 4.5 Nausea and labyrinth disorder 10mg Tablets, MHRA Drug safety Update Aug 2013: Metoclopramide risk of neuroloigal adverse 1st line-Metoclopramide 5mg/5ml solutionn, effects 10mg/2ml Injection 10mg Tablets, MHRA Drug Safety Update May 2014: Domperidone risks of cardiac side effects 1st line-Domperidone 5mg/5ml Susp, MHRA Drug Safety Update April 2016: Apomorphine with domperidone: 30mg Suppos minimising risk of cardiac side effects 1st line-Cinnarizine 15mg Tablets 1mg Tablets, 1st line-Granisetron 1mg/ml Injection 4mg, 8mg Tablets, 1st line-Ondansetron 4mg/5ml solutionn, 2mg/ml Injection 3mg Buccal Tablets, 5mg Tablets, 2nd line-Prochlorperazine 5mg/5ml solutionn, 12.5mg/ml Injection Cyclizine Injection – not usually recommended as liable to abuse consider an 2nd line-Cyclizine 50mg Tablets, alternative option, regional CD LIN advice 300microgram Tablets, 2nd line-Hyoscine 1mg/72hrs Patches , Hydrobromide 400microgram/ml, 600microgram/ml Injection 4.5.1 Meniere's 2nd line-Betahistine 8mg, 16mg Tablets disease 4.6 Pain 500mg Tablets, 500mg soluble Tablets, 1st line - Paracetamol 120mg/5ml, 250mg/5ml Suspension, 125mg , 500mg Suppos Non-opioid and 2nd line - Co-Codamol 30/500 Tablets compound analgesics 2nd line-Co-Dydramol 10/500 Tablets Non-opioid and compound analgesics Paracetamol/Tramadol combination (Tramacet): sub-therapeutic doses of Paracetamol with tramadol paracetamol and tramadol. Similar efficacy to Ibuprofen and co-codamol 30/500. Not recommended for prescribing (Tramacet®) Not routinely recommended for prescribing in Primary Care, added to Red list MOPB August 2017 Non-opioid and Not recommended Highly toxic in even small overdoses. The MHRA has compound analgesics - Co-Proxamol Not recommended for prescribing withdrawn the marketing authorisation for co-proxamol due to the poor cont. risk/benefit profile of the drug 15mg, 30mg Tablets, 1st line-Codeine 25mg/5ml solution, 60mg/ml Injection 30mg Tablets, 2nd line -Dihydrocodeine 10mg/5ml solution 50mg Capsules, 3rd line-Tramadol Prescribe Marol for tramadol mr 100mg and 200mg 50mg, 100mg, 150mg, 200mg MR Tablets 200mg Tablets, 3rd line-Meptazinol Acute pain only 100mg/ml Injection Brand prescribing recommended. Prescribe Zomorph® capsules for modified 1st line- Morphine All release preparations Renal impairment or allergy to morphine Prescribe Longtec®for the MR form and Oxynorm® for immediate release. 2nd line-Oxycodone All Oxycodone ONCE daily formulations not recommended for prescribing in primary or secondary care due to safety concerns of frequency of dosing compared to the Opioid Analgesics twice daily dosing products already on the formulary MOPB 1 March 2018 12microgram/hr, 25microgram/hr, 3rd line-Fentanyl 50microgram/hr, 75microgram/hr, Prescribe Matrifen® 100microgram/hr patch Oxycodone/naloxone prolonged release (Targinact®) tablets: equivalent analgesic Oxycodone/naloxone effect to that of oxycodone. Naloxone does not eliminate constipation and long prolonged release Not recommended for prescribing term effects are uncertain. Not routinely recommended for prescribing in Primary (Targinact®) Care, added to Red list MOPB August 2017 100microgram buccal Tablets, 100microgram, 200microgram, 300microgram, 400microgram, 600microgram, 800microgram s/l Restricted-Fentanyl Tablets 200microgram, 400microgram, 600microgram, , 800microgram buccal Tablets, 4.6 Pain - cont. Fentanyl immediate release Not routinely recommended for prescribing added to RED List Sept MOPB 2017. Nasal Spray and Lozenges products Palliative care team only may prescribe in exceptional circumstances Not recommended - Fentanyl Transdermal Not recommended for prescribing System IONSYS® Licenced for use in hospital only - IONSYS® decision Butec® is the lowest cost 7 day patch with an identical formulation to Butrans® 200microgram, 400microgram s/l Tablets. Opioid Analgesics MOPB May 16. 3rd line-Buprenorphine Prescribing 3 day buprenorhine patches is NOT recommended For further information on appropriate prescribing of buprenorphine patches please click here 1st line- Diamorphine 5mg, 10mg, 30mg, 100mg, 500mg Injection 50mg Tablets, 2nd line-Pethidine 50mg/ml Injection See PAC recommendations for the use of verapamil, 4.6.1 Headaches PAC March 2017 Oxygen in cluster headaches triptans and oxygen in cluster headaches 50mg, 100mg Tablets, 1st line-Sumatriptan 6mg/0.5ml Injection, 10mg/0.1ml 20mg/0.1ml Nasal Spray 2nd line- Naratriptan 2.5mg Tablets 4.6.1a Migraine 2nd line- Rizatriptan 10mg Melts Botulinum toxin A Specialist prescribed only in accordance with NICE TA 260 Fremanezumab Specialist prescribed only in accordance with NICE TA 631 Galcanezumab Added to formulary pending place in pathway Specialist prescribed only in accordance with NICE TA 659 500microgram, 1.5mg Tablets, Migraine Prophylaxis 1st line-Pizotifen 250microgram/5ml Elixir 4.6.2 Neuropathic 10mg, 25mg, 50mg Tablets, 1st line- Amitriptyline Unlicensed Pain 25mg/5ml solution 100mg, 200mg Tablets, 400mg Tablets 100mg , 200mg ChewTablets, 1st line- Carbamazepine Trigeminal Neuralgia 200mg MR, 400mg MR Tablets 100mg/5ml Liquid, 2nd line- Nortriptyline 10mg, 25mg Tablets 100mg, 300mg, 400mg Capsules, MHRA Drug Safety Update Oct 2017 Gabapentin (Neurontin): risk of severe 2nd line- Gabapentin 600mg, 800mg Tablets respiratory depression 2nd line- Duloxetine 0mg, 60mg Capsules, Cymbalta® 3rd line- Pregabalin Capsules Branded generic Alzain® for adults with Neuropathic pain. MOPB Mar 17 Not recommended for localised neuropathic pain. Prescribing should be restricted to patients with postherpetic neuralgia, in whom alternative treatments are Lidocaine plasters Not recommended for prescribing ineffective or contraindicated. Not routinely recommended for prescribing in Primary Care, added to Red list MOPB August 2017 4.7 Sleep disorder 10mg Tablets, 1st line-Temazepam 10mg/5ml Liquid 2nd line - Zopiclone 3.75mg, 7.5mg Tablets 4.7.1 Insomnia 2nd line - Nitrazepam 5mg Tablets 10mg, 25mg Tablets, 2nd line - Promethazine 5mg/5ml Liquid Modafinil 100mg, 200mg Tablets Specialist initiation. Non-formulary for EPUT. Pitolisant Not recommended for prescribing Specialist knowledge required for prescribing and monitoring MOPB March 2018 4.7.2 Narcolepsy Not recommended for prescribing in primary or secondary care. June 16. Click to Sodium oxybate Not recommended for prescribing see PAC summary 4.8 Substance dependence: Alcohol, Nicotine, Opioid Disulfiram 200mg Tablets Specialist initiation-Essex DAT Acamprosate 333mg Tablets Specialist initiation - Essex DAT Nalmefene Not recommended for prescribing in Primary Care Specialist prescribed in line with NICE TA 325 Naltrexone 50mg Tablets Specialist initiation-Essex DAT NRT All See Smoking Cessation Guidance Varenicline 500microgram, 1mg Tablets See Smoking Cessation Guidance Bupropion 150mg MR Tablets Methadone 1mg/1ml SF Liquid Specialist initiation-Essex DAT Buprenorphine Subutex® 2mg, 8mg s/l Tablets Specialist initiation-Essex DAT Buprenorphine oral Similar clinical outcomes and adverse effects as sublingual buprenorphine. Non- Not recommended for prescribing lyophilisate (Espranor®) formulary for EPUT. MOPB 2017 Provided by STARS only. Not recommended for prescribing in primary or Naloxone Pre-filled syringe secondary care MOPB May 16 NICE TA 494 Naltrexone–bupropion is not recommended within its marketing Other Naltrexone -bupropion Not recommended for prescribing authorisation for managing overweight and obesity in adults alongside a reduced- calorie diet and increased physical activity.