4. Drugs acting on the Central Nervious System

For patients referred for assessment by psychiatrists of Salford Mental Health NHS Trust, refer to their Trust Formulary

4.1 Hypnotics and Anxiolytics

4.1.1 Hypnotics chloral hydrate (SCBU only) clomethiazole (ICU and Anaesthetics and Palliative Care only) sodium oxybate temazepam Melatonin (Circadin®) (sleep clinic only) 4.1.2 Anxiolytics chlordiazepoxide diazepam oxazepam (refer to Mental Illness Unit)

4.2 Drugs used in psychoses and related disorders

4.2.1 drugs (Clozaril®) (For use in the treatment of Parkinson's disease psychosis by consultant Neurologists - Dr Hackett, Dr Dick and Dr Kellett. Written agreement from GPs to take blood for required haematological monitoring MUST be obtained PRIOR to commencing therapy) (schizophrenia only) (refer to Mental Illness Unit)

decanoate (refer to Mental Illness Unit) 4.2.2 Antipsychotic depot injections decanoate (refer to Mental Illness Unit) (refer to Mental Illness Unit) zuclopenthixol decanoate (refer to Mental Illness Unit)

4.2.3 Antimanic drugs lithium carbonate lithium citrate (liquid only) valproic acid - 'semisodium ' (neuropsychiatry and neurorehabilitation for the treatment of manic episodes associated with bipolar disorder)

4.3

4.3.1 Tricyclic and related drugs

4.3.2 Monoamine-oxidase inhibitors phenelzine (refer to Mental Illness Unit)

4.3.3 SSRIs and related antidepressants (for use in accordance with the Palliative Care Pain and Symptom Control Guidelines) (first line SSRI) (for use in pruritus in accordance with the Palliative Care Pain and Symptom Control Guidelines)

( Directorate only)

(for use in pruritus in accordance with the Palliative Care Pain and Symptom Control Guidelines)

4.3.4 Other antidepressant drugs (for use in accordance with Acute Stroke Protocols) (for use in accordance with Acute Stroke Protocols and the Palliative Care Pain and Symptom Control Guidelines)

4.4 CNS stimulants and other drugs used for attention deficit hyperactivity disorder

Modafinil (for use by consultant neurologists only in the treatment of narcolepsy)

4.5 Drugs used in the treatment of obesity

4.5.1 Anti-obesity drugs acting on the gastro- intestinal tract methylcellulose

4.6 Drugs used in nausea and

hyoscine hydrobromide injection (Haematology, Oncology and third line in PONV only) ondansetron 8mg oral tablets (Haematology and Oncology only)

4.7 Analgesics

4.7.1 Non- analgesics paracetamol intravenous infusion paracetamol oral tablets

4.7.2 Opioid analgesics CD (including sublingual tablets and Transtec® patches) buprenorphine CD (BuTrans® patches) (restricted for use by consultants in pain management only and in patients who have received codeine and low dose morphine)

codeine phosphate (injection CD)

diamorphine CD

fentanyl CD

fentanyl CD lozenges (lozenges restricted for procedural pain and pain associated with dressing changes only and in accordance with the Palliative Care Pain and Symptom Control Guidelines; consultant only for all other indications) fentanyl CD patches (see Trust guidance) hydromorphone CD (for Palliative Care Team and Renal directorate only) CD meptazinol (according to Trust Musculoskeletal Pain Guidelines only) morphine CD morphine modified release CD (Zomorph®) oxycodone CD (for use by the Acute Pain Team and Anaesthetists, in elderly patients with traumatic or post operative pain, in patients with renal impairment, for patients intolerant of morphine and for use in patients receiving palliative care in accordance with Trust Palliative Care Pain and Symptom Management Guidelines) CD (Obstetrics , Endoscopy and Anaesthetics for post-operative shivering only) (according to Trust Musculoskeletal Pain Guidelines only and for use by Mr Jari post-operatively for a maximum course of two weeks duration)

amitriptyline

carbamazepine

4.7.3 Neuropathic pain

(Neurology, Diabetology, Pain Teams and Palliative Care only)

sodium valproate

Migraleve®

4.7.4 Antimigraine drugs (Neurology, A&E department and EAU only) (Unlicensed – neurology consultants only)

4.8 Antiepileptics carbamazepine 4.8.1 Control of clobazam (Neurology only) clonazepam felbamate (Epileptologists of Neurology directorate only) Follow restricted high cost drug procedure when prescribing felbamate gabapentin

( Neurology only. For patients who have failed to respond to older AEDs, or for whom the older AEDS are unsuitable due to interactions, contraindications to the medication, intolerance of the medication or teratogenicity risk)

(Neurology only) (Neurology only for use in accordance with NICE guidance) phenobarbital CD (Neonatal Unit and Neurology only) phenytoin pregabalin (Neurology, Diabetology, Pain Teams and Palliative Care only) 4.8.2 Drugs used in status epilepticus sodium valproate vigabatrin (Neurology only) (For use on the recommendation of a consultant neurologist only in accordance with NICE guidance)

clonazepam diazepam lorazepam midazolam (intranasal - Neurosciences only) paraldehyde phenytoin

4.9 Drugs used in and related disorders

4.9.1 drugs used in parkinsonism (Neurology only) (Neurology and Elderly care only) co-beneldopa co-careldopa co-careldopa intestinal gel (Duodopa®) for use with enteral feeding tubes (consultant only) (Neurology and Elderly care only) (adjunct therapy by Specialist Parkinson's disease clinics only within Neurology and Elderly care directorates)

4.9.2 Antimuscarinic drugs used in parkinsonism Stalevo® (levodopa//entacapone) (Neurology only) 4.9.3 Drugs used in essential , chorea, tics and - to be prescribed and supplied only by hospital neurologists/pharmacy - Follow restricted high cost drug procedure when prescribing tolcapone related disorders haloperidol (Neurology only - in accordance with NICE guidance) botulinum A toxin (Botox® and Dysport®) (Neurology and Neurorehabilitation directorates only) botulinum A toxin (Dysport®) (for use by consultant oral and maxillofacial surgeons only, in the treatment of masseteric hypertrophy only) botulinum A toxin (Botox®) (Urology directorates only) - follow restricted high cost drug procedure when prescribing botulinum A toxin (Botox®)

4.10 Drugs used in substance dependence

buprenorphine CD disulfiram methadone CD naltrexone (refer to Mental Illness Unit) nicotine products

4.11 Drugs for dementia Please refer all patients to the Old Age Psychiatry Service of Salford (Prestwich Hospital) for assessment of suitability for drug treatment (except those with Parkinson's Disease dementia under the care of Neurology)

rivastigmine (For use by neurologists or neuropsychiatrists only in the treatment of Parkinson's disease dementia) 4.12 Miscellaneous

3,4 diaminopyridine (unlicensed - Neurology directorate only) bone wax sterile (Neurosurgery and Anaesthetics only) Duraseal Dural Sealant System (Neurosciences only) Tisseal (Neurosciences only)