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Mental Health (General Adult Psychiatry) Specialist Formulary List

**Other indications for particular drugs may be included on completion of further specialist lists**

Formulary medicines generally provide first and second-line treatment options. The undernoted sections of the Tayside Area Formulary (TAF) should be used in conjunction with this specialist formulary list.

For information on use of unlicensed medicines or medicines used 'off-label' - click here

The following medicines are approved for prescribing by or on the recommendation of a Psychiatrist:

In the event of a broken link please forward details to [email protected] Please include the location and full title of the link MEDICINE SUMMARY OF RESTRICTED INDICATION CATEGORY PROTOCOL

Second-generation drugs ( drugs) is a Green traffic light first choice atypical antipsychotic. See formulary chapter 04.02.01 for further information on antipsychotic drugs.

Olanzapine tablets, orodispersible Schizophrenia, combination therapy for , Algorithm for antipsychotic treatment of

tablets preventing recurrence in . schizophrenia (under review) Monotherapy for mania. Pharmacological Management of Acute Behavioural Disturbance in Adult In-Patient immediate release (IR) Schizophrenia. Mental Health Services tablets Treatment of mania in bipolar disorder. in patients with Parkinson’s disease (NHS Tayside Staffnet intranet links only). (unlicensed use ‘off-label’).

Amisulpiride tablets Schizophrenia. Algorithm for antipsychotic treatment of

schizophrenia (under review) tablets Schizophrenia (in adults) where patients have (NHS Tayside Staffnet intranet link only). experienced unacceptable adverse effects on previous treatment or in patients at increased risk of developing adverse effects.

Clozapine tablets (Clozaril®) Schizophrenia in patients unresponsive to at least 2

, one being atypical, or intolerant of, conventional antipsychotic drugs. Psychosis in Parkinson’s disease Aripiprazole injection Control of agitation and disturbed behaviour in Pharmacological Management of Acute

schizophrenia when oral therapy is not appropriate. Behavioural Disturbance in Adult In-Patient Use is restricted to the Intensive Psychiatric Care Unit Mental Health Services (IPCU) or Specialist Mental Health Services. (NHS Tayside Staffnet intranet link only).

First-generation antipsychotic drugs (typical antipsychotic drugs) Haloperidol is a Green traffic light formulary typical antipsychotic. See formulary chapter 04.02.01 for further information on antipsychotic drugs.

Zuclopenthixol tablets Schizophrenia and other psychoses. Algorithm for antipsychotic treatment of

schizophrenia (under review)

Haloperidol injection 5mg/mL Schizophrenia and other psychoses, mania, short-term Pharmacological Management of Acute adjunctive management of psychomotor agitation, (may be Behavioural Disturbance in Adult In-Patient excitement, and violent or dangerously impulsive prescribed by Mental Health Services behaviour, when oral route not possible. GPs in a (NHS Tayside Staffnet intranet link only) Psychiatric Emergency)

Zuclopenthixol acetate injection (Clopixol Short-term management of acute psychosis, mania, or Pharmacological Management of Acute

Acuphase®) exacerbations of chronic psychosis. Behavioural Disturbance in Adult In-Patient Mental Health Services (NHS Tayside Staffnet intranet link only).

Benzodiazepines for pharmacological management of acute behavioural disturbance

Lorazepam injection Acute management of violent / disturbed behaviour Pharmacological Management of Acute when oral route not possible (unlicensed use ‘off- (may be Behavioural Disturbance in Adult In-Patient label’) prescribed by Mental Health Services Licensed indications include treatment of acute anxiety GPs in a (NHS Tayside Staffnet intranet link only). states, acute excitement or acute mania. Psychiatric Emergency)

Antihistamines for pharmacological management of acute behavioural disturbance

Promethazine hydrochloride tablets, Emergency sedation (short-term use) in patients with Pharmacological Management of Acute elixir, injection violent / disturbed behaviour. (may be Behavioural Disturbance in Adult In-Patient prescribed by Mental Health Services GPs in a Psychiatric (NHS Tayside Staffnet intranet link only) Emergency)

Medication to manage adverse effects of drugs used for pharmacological management of acute behavioural disturbance

Flumazenil injection In addition to resuscitation equipment and medication if Pharmacological Management of Acute benzodiazepine-induced respiratory depression is (may be Behavioural Disturbance in Adult In-Patient suspected. prescribed by Mental Health Services GPs in an Emergency) (NHS Tayside Staffnet intranet link only)

Procyclidine injection Emergency treatment for acute drug-induced dystonic reactions. (may be prescribed by GPs in an Emergency)

Benzodiazepines for alcohol withdrawal

Chlordiazepoxide capsules Alcohol withdrawal within Mental Health or Substance NHS Tayside Alcohol Withdrawal Protocol:

Misuse Services. Chlordiazepoxide

Antipsychotic Depot Injections MEDICINE SUMMARY OF RESTRICTED INDICATION CATEGORY PROTOCOL decanoate oily injection Maintenance in schizophrenia and other psychoses. Algorithm for antipsychotic treatment of Haloperidol decanoate oily injection Maintenance in schizophrenia and other psychoses. schizophrenia (under review) (Note: (NHS Tayside Staffnet intranet link only). Zuclopenthixol decanoate oily Maintenance in schizophrenia and other psychoses. in Dundee and injection Perth & Kinross) Aripiprazole prolonged release Maintenance treatment of schizophrenia in adult patients

suspension for injection who have responded to oral aripiprazole and depot (intramuscular) 400mg (200mg/mL) medication is required due to problems with compliance. (Abilify Maintena ®) Schizophrenia and other psychoses in patients who

Risperidone prolonged-release require an atypical antipsychotic and who are tolerant to injection (Risperdal Consta®) risperidone by mouth. Maintenance treatment of schizophrenia in adult patients Note: Oral is not recommended by

Paliperidone palmitate prolonged- stabilised with paliperidone or risperidone. Restricted to SMC. release suspension for injection use where an atypical antipsychotic is appropriate and Algorithm for antipsychotic treatment of (Xeplion®) depot medication is required due to problems with schizophrenia (under review) compliance. (NHS Tayside Staffnet intranet link only).

Mood Stabilisers (antimanic drugs) MEDICINE SUMMARY OF RESTRICTED INDICATION CATEGORY PROTOCOL carbonate tablets (Priadel®, Treatment and prophylaxis of mania, bipolar disorder,

Camcolit®) and recurrent depression; aggressive or self-mutilating Lithium citrate liquid (Priadel®) behaviour. Valproic acid (as semisodium ) Treatment of manic episode in bipolar disorder when

(Depakote®▼) lithium is contraindicated or not tolerated. Continuation of treatment after manic episode in patients who have responded to valproic acid for acute mania. Sodium valproate tablets, oral solution Treatment of manic episode in bipolar disorder when

lithium is contraindicated or not tolerated (unlicensed use ‘off-label’). tablets, m/r tablets, Prophylaxis of bipolar disorder in patients unresponsive

liquid to lithium. tablets, dispersible tablets Monotherapy or adjunctive therapy for prevention of

depressive episodes in patients with bipolar disorder who experience predominantly depressive episodes.

Antidepressant Drugs MEDICINE SUMMARY OF RESTRICTED INDICATION CATEGORY PROTOCOL Selective serotonin re-uptake inhibitors (SSRIs) tablets After other SSRIs have been tried for major is the formulary first choice SSRI. See

depressive episodes, generalised anxiety disorder. formulary chapter 04.03 for further information on SSRIs. Tricyclic and related drugs is a Green traffic light formulary drug. See formulary chapter 04.03 for further information on antidepressant drugs. capsules Depressive illness, phobic and obsessional states.

Imipramine tablets Depressive illness.

Monoamine-oxidase inhibitors (MAOIs) and reversible MAOIs tablets Depressive illness refractory to treatment with other

, social anxiety disorder. tablets Depressive illness refractory to treatment with other

antidepressants. Other antidepressant drugs and are Green traffic light formulary antidepressant drugs. See formulary chapter 04.03 for further information on antidepressant drugs. 30mg, 60mg capsules Major depressive disorder who have failed to respond

to, or are unable to tolerate, initial treatment options. Augmentation in treatment resistant depression tablets (Priadel®, To augment antidepressants in treatment-resistant

Camcolit®) depression (unlicensed use ‘off-label’). Lithium citrate liquid (Priadel®) Anxiety disorders Pregabalin capsules Generalised anxiety disorder where SSRIs or

venlafaxine are ineffective, poorly tolerated, or considered clinically inappropriate. Attention deficit hyperactivity disorder

Methylphenidate hydrochloride Treatment of ADHD in adults (unlicensed use ‘off- Adult ADHD Treatment Shared Care Agreement label’) in accordance with the local Adult ADHD Treatment Shared Care Agreement (NHS Tayside Staffnet intranet link only). Lisdexamfetamine dimesylate (Elvanse Treatment of ADHD in adults in accordance with the Adult®▼) local Adult ADHD Treatment Shared Care Agreement

Dexamfetamine sulfate Treatment of ADHD in adults (unlicensed use ‘off- label’) in accordance with the local Adult ADHD Treatment Shared Care Agreement ® (Strattera ) Treatment of ADHD in adults where the presence of symptoms of ADHD have been confirmed as pre- existing in childhood and in accordance with the local Adult ADHD Treatment Shared Care Agreement.

Please refer to the following national guidelines/resources for further information:  NICE Guideline 10: Violence and aggression : short-term management in mental health, health and community settings (May 2015)  SIGN Guideline 131: Management of Schizophrenia. A National Clinical Guideline (March 2013)  NICE Clinical Guideline 185: Bipolar disorder, Sept 2014 (last updated Feb 2016).  Evidence based guidelines for treating bipolar disorder: Revised third edition – recommendations from the British Association for Psychopharmacology 2016  NICE Clinical Guideline 90 (Oct 2009) Depression in adults: recognition and management (last updated April 2016)  NICE Clinical Guideline 91 (Oct 2009) Depression in adults with a chronic physical health problem: recognition and management  NICE Clinical Guideline 113 (Jan 2011) Generalised anxiety disorder and panic disorder in adults: management  SIGN Guideline 114 Non-pharmaceutical management of depression in adults. A National Clinical Guideline (Jan 2010)  SIGN Guideline 127 Management of perinatal mood disorders March 2012  The Maudsley Prescribing Guidelines 12th Edition, 2015

Traffic light status information To be prescribed by Hospital Specialists Only.

Can be prescribed in General Practice under the direction of a Specialist.

Updated: 27th April 2020