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South Staffordshire Joint Formulary
Cannock Chase Clinical Commissioning Group
East Staffordshire Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
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 Formulary Chapter 4: Central nervous system - Full Chapter
04.07  Expand sub section  Analgesics
Paracetamol
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Formulary
Green
Paracetamol Tablet 500mg
Paracetamol Capsule 500mg - More Expensive than Tablets
Paracetamol Tablet Soluble 500mg - More Expensive than Tablets

Paracetamol Oral Solution Paediatric 120mg/5ml
Paracetamol Oral Solution Paediatric 120mg/5ml S/F
Paracetamol Oral Suspension 250mg/5ml
Paracetamol Oral Suspension 250mg/5ml S/F
Paracetamol Syrup 120mg/5ml


 
Link  UKMI Q&A: Can Breastfeeding mothers take paracetamol?
   
Ibuprofen
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Formulary
Green
Tablets 200 and 400mg
Oral Suspension SF 100mg/5ml
Oral Suspension 100mg/5ml



See also section 10.1.1
 
Link  Click Here to go to Section 10.1.1:
   
04.07.01  Expand sub section  Non-opioid analgesics and compound analgesic preparations
04.07.01  Expand sub section  Compound analgesic preparations
Co-Codamol - 8/500mg
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Formulary
Green

Co-Codamol Tablet 8mg/500mg
Co-Codamol Effervescent Tablet 8mg/500mg

NOT an evidence based choice but patients may perceive benefit.
Please note over the counter (OTC) sale is limited to three days only.

 
   
Co-Codamol - 30/500mg
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Formulary
Green

Co-Codamol Capsule 30mg/500mg
Co-Codamol Tablet 30mg/500mg
Co-Codamol Effervescent Tablet 30mg/500mg

Prescribing as separate components allows dosing flexibility and is less expensive (Applicable to primary care only).

Ensure soluble forms are prescribed only if appropriate.

 
   
04.07.02  Expand sub section  Opioid analgesics
 note 

The Faculty of Pain Medicine has produced resources for healthcare professionals around opioid prescribing:www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

MHRA safety leaflet: Opioid medicines and the risk of addiction

Codeine Phosphate
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Formulary
Green
Codeine Phos Tablet 15mg
Codeine Phos Tablet 30mg
Codeine Phos Tablet 60mg
Codeine Phos Linctus 15mg/5ml S/F
 
   
Controlled Drug Dihydrocodeine Tartrate
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Formulary
Green
Dihydrocodeine Tartrate Tablet 30mg 
   
Controlled Drug Tramadol
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Formulary
Green
Tramadol HCl Capsule 50mg

Tramulief SR 100 mg tablets
Tramulief SR 150 mg tablets
Tramulief SR 200 mg tablets

ONLY use M/R Preparation if compliance really is a problem 
Link  Tramadol and seizures - MHRA CSM Guidance 1996
Link  UKMI Q&A: risk of developing Serotonin Syndrome following concomitant use of tramadol with selective serotonin reuptake inhibitors (SSRIs)
   
Controlled Drug Morphine Sulfate - Oral Solution
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Formulary
Green
Morph Sulfate Oral Solution 10mg/5ml (POM)
Morph Sulfate Oral Solution 20mg/1ml (Controlled Drug)
 
   
Controlled Drug Morphine Sulfate (ZOMORPH CAPSULES)
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Formulary
Green

Zomorph Capsule 10mg M/R
Zomorph Capsule 30mg M/R 
Zomorph Capsule 60mg M/R  
Zomorph Capsule 100mg M/R 
Zomorph Capsule 200mg M/R 
 
 
Prescribe M/R Capsules as brand Zomorph in preference to M/R Tablets as more cost effective. Please prescribe by brand to avoid medication errors (Applicable in Primary care only).

 
   
Controlled Drug Oxycodone
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Formulary
Green

Shortec Capsule 5mg 
Shortec Capsule 10mg 
Shortec Capsule 20mg

Longtec HCl Tablet 5mg M/R
Longtec HCl Tablet 10mg M/R 
Longtec HCl Tablet 15mg M/R
Longtec HCl Tablet 20mg M/R 
Longtec HCl Tablet 30mg M/R
Longtec HCl Tablet 40mg M/R 
Longtec HCl Tablet 60mg M/R
Longtec HCl Tablet 80mg M/R

Longtec HCl Tablet 120mg M/R

Oxycodone HCl Oral Solution 10mg/1ml S/F
Oxycodone HCl Oral Solution 5mg/5ml S/F

 

Please prescribe the normal release as Shortec® and the modified release as longtec® as this is more cost effective (Applicable in Primary care only).

 
   
Controlled Drug Fentanyl
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Formulary
Green

Fencino Transdermal Patch 12mcg/hr
Fencino Transdermal Patch 25mcg/hr
Fencino Transdermal Patch 50mcg/hr
Fencino Transdermal Patch 75mcg/hr
Fencino Transdermal Patch 100mcg/hr

Useful if patient cannot swallow tablets
Prescribe by Brand - Fencino recommended 
(Applicable in Primary care only). 

 
   
Controlled Drug Buprenorphine 5mcg Patch (BuTec® patch)
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Restricted Drug Restricted
Green

Please prescribe by brand Butec® (equivalent to Butrans®) as more cost effective (Applicable in Primary care only).

Note: Low dose may be useful for frail elderly patients or similar patients sensitive to side-effects of morphine sulphate or fentanyl

Self-adhesive, beige, buprenorphine, ‘5’ patch (releasing 5 micrograms/hour for 7 days)

See the Strong Opioids for Persistant Non-Cancer Pain Guidelines for further information

 
Link  Strong Opioids for Persistant Non-Cancer Pain Guidelines
   
Controlled Drug Buprenorphine 35mcg Patch (Transtec® patch)
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Restricted Drug Restricted
Green

Note: Low dose may be useful for frail elderly patients or similar patients sensitive to side-effects of morphine sulphate or fentanyl

Self-adhesive, skin-coloured, buprenorphine, ‘35’ patch (releasing 35 micrograms/hour for 96 hours)

See the Strong Opioids for Persistant Non-Cancer Pain Guidelines for further information  
Link  Strong Opioids for Persistent Non-Cancer Pain
   
Controlled Drug Diamorphine
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Formulary
Green

Diamorphine Tablets 10mg

5mg Powder for Soln for Injection Ampoules 
10mg Powder for Soln for Injection Ampoules
30mg Powder for Soln for Injection Ampoules
100mg Powder for Soln for Injection Ampoules

500mg Powder for Soln for Injection Ampoules

 
Link  22/05/2019: Diamorphine 5mg injection supply issues
   
04.07.03  Expand sub section  Neuropathic pain to top
Amitriptyline
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Formulary
Green
Amitriptyline Tablets 10mg, 25mg, 50mg




Unlicensed use in Neuropathic Pain is recommended by NICE CG96 
   
Controlled Drug Gabapentin
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Formulary
Green

Capsules 100mg
Capsules 300mg
Capsules 400mg

Oral Solution 50mg/ml

CDAs of the 1st April 2019 Gabapentin is re-classified as a Schedule 3 Controlled Drug

 
   
Controlled Drug Pregabalin
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Formulary
Green

Pregabalin Capsule 25mg
Pregabalin Capsule 50mg
Pregabalin Capsule 75mg
Pregabalin Capsule 100mg
Pregabalin Capsule 150mg
Pregabalin Capsule 200mg
Pregabalin Capsule 225mg
Pregabalin Capsule 300mg
Pregabalin Oral Soln 100mg/5ml S/F - for patients with swallowing difficulties ONLY

The Capsules are flat priced so dose optimise when increasing Daily Doses, e.g. 1x50mg twice a day is cheaper to prescribe than 2x25mg twice a day.

CDAs of the 1st April 2019 Pregabalin is re-classified as a Schedule 3 Controlled Drug

 
   
Carbamazepine
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Formulary
Green
Tablets 100mg
Tablets 200mg
Tablets 400mg

 
   
Nortriptyline
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Formulary
Green
Allegron Tablets 10mg and 25mg

Please note the 10mg & 25mg Tablets are VERY EXPENSIVE items 
   
04.07.04  Expand sub section  Antimigraine drugs
04.07.04.01  Expand sub section  Treatment of the acute migraine attack
Aspirin
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Formulary
Green
Aspirin Tablet 300mg

Because of an association with Reye's syndrome, preparations containing aspirin should not be offered to people aged under 16 years. 
Link  MHRA : Oral salicylate gels: not for use in those younger than age 16 years
   
Paracetamol (See Section 4.7.1)
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Formulary
Green
 
   
Domperidone
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Formulary
Green
Please refer to Section 4.6 
Link  Click Here to go to Section 04.07:
   
Metoclopramide (Section 4.6 also)
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Formulary
Green
Please refer to section 4.6

Metoclopramide HCl Tablet 10mg 
Link  Click Here to go to Section 04.07:
   
04.07.04.01  Expand sub section  5HT1 agonists
Sumatriptan
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Formulary
Green
Sumatriptan Tablet 100mg
Sumatriptan Tablet 50mg
Sumatriptan Aq Nasal Spray 20mg/0.1ml Ud
 
   
Zolmitriptan
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Formulary
Green

NICE Recommend this for Menstrual-related Migraine. If this is not tolerated then consider Frovatriptan 2.5mg tablets instead for menstrual related migraine. (Unlicensed indication)

 
   
Rizatriptan
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Formulary
Green
 
   
04.07.04.02  Expand sub section  Prophylaxis of migraine
Botulinum Toxin Type A (Botox®)
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Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA260: Botulinum toxin type A for the prevention of headaches in adults with chronic migraine
   
ErenumabBlack Triangle (Aimovig®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA682: Erenumab for preventing migraine
   
FremanezumabBlack Triangle (Ajovy®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA631: Fremanezumab for preventing migraine
   
GalcanezumabBlack Triangle (Emgality®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Restriction: In line with NICE Guidance only

 
Link  NICE TA659: Galcanezumab for preventing migraine
   
Pizotifen
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Formulary
Green

Pizotifen Malate_Tab 1.5mg
Pizotifen Malate_Tab 500microgram

Liquid Preparations are Unlicensed and Expensive

 
   
Propranolol
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Formulary
Green
See Section 2.4

See link for Chapter 2.4.9 
Link  Beta-Adrenoceptor blocking Drugs - Propanolol Hydrochloride
   
Topiramate Tablets
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Formulary
Green
Topiramate Tabs 25mg
Topiramate Tabs 50mg
Topiramate Tabs 100mg
Topiramate Tabs 200mg

 
Link  Control of the Epilepsies - Topiramate
   
04.07.04.03  Expand sub section  Cluster headache to top
 ....
 Non Formulary Items
actipatch

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Non Formulary

Pulsed electromagnetic stimulator patches

This has recently been made available on the NHS. locally the evidence needs to be reviewed before a decision can be made as to whether this is supported locally.

Currently it is non formulary.

 
Controlled Drug  Alfentanyl Sublingual Spray 5 mg in 5mL

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Almotriptan  (Almogran®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Aspirin  (Caprin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Aspirin  (Nu-Seals® Aspirin)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Aspirin and codeine  (Co-codaprin®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Aspirin and papaveretum  (Aspav®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Buprenorphine  (Temgesic®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Buprenorphine 5mcg Patch  (Butrans®)

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Non Formulary Butrans non-formulary please prescribe branded generic Butec as more cost effective. Butec is made in the same manufacturing unit as Butrans.
 
Clonidine Hydrochloride

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Non Formulary
 
Clonidine Hydrochloride  (Catapres®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Clonidine Hydrochloride  (Dixarit®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Clonidine Hydrochloride  (Dixarit®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Co-proxamol

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Non Formulary

NHS England Guidance for CCGs4:

  • prescribers in primary care should not initiate co-proxamol for any new patient.
  • prescribers should be supported in deprescribing co-proxamol in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change.

No routine exceptions have been identified.

Alternative analgesics e.g. paracetamol and codeine or co-codamol tablets.

 
Controlled Drug  Dextromoramide

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Non Formulary
 
Controlled Drug  Dipipanone  (Diconal®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Eletriptan  (Relpax®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ergotamine Tartrate  ((Cafergot®))

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary NON formulary not recommended for prescribing
 
Ergotamine Tartrate  (Migril®)

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Non Formulary Non formulary not recommended to prescribe
 
Controlled Drug  Fentanyl  (Actiq®)

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Non Formulary

NHS England has identified this product as an item that should not be routinely prescribed in primary care (July 2017).

 
Controlled Drug  Fentanyl  (Effentora® buccal tablets)

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Non Formulary

NHS England has identified this product as an item that should not be routinely prescribed in primary care (July 2017).

 
Controlled Drug  Fentanyl  (Instanyl® nasal spray)

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Non Formulary

NHS England has identified this product as an item that should not be routinely prescribed in primary care (July 2017).

 
Fentanyl Buccal Film  (Breakyl)

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Non Formulary

NHS England has identified this product as an item that should not be routinely prescribed in primary care (July 2017).

 
Controlled Drug  Fentanyl Nasal Spray  (PecFent®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary

NHS England has identified this product as an item that should not be routinely prescribed in primary care (July 2017).

 
Controlled Drug  Fentanyl sublingual tablets  (Abstral®)

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Non Formulary

NHS England has identified this product as an item that should not be routinely prescribed in primary care (July 2017).

 
Controlled Drug  Hydromorphone  (Palladone®)

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Non Formulary
 
Controlled Drug  Hydromorphone Hydrochloride  (Palladone® SR)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ketamine oral solution

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Meptazinol  (Meptid®)

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Non Formulary
 
Controlled Drug  Methadone

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Methysergide  (Deseril®)

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Non Formulary
 
Controlled Drug  Morphine and cyclizine  (Cyclimorph®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Morphine Sulfate  (MST Continus®tablets)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary

Non formulary as is more cost effective to prescribe as Zomorph capsules

 
Controlled Drug  Morphine Sulfate  (Oramorph®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary

Please prescribe generically

 
Controlled Drug  Morphine Sulfate  (Sevredol®tablets)

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Non Formulary
 
Naratriptan  (Naramig®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nefopam

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Non Formulary
 
Nefopam  (Acupan®)

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Non Formulary
 
Controlled Drug  Papaveretum

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Papaveretum

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol  (Panadol OA®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol  (Perfalgan®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol and codeine  (Codipir®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol and codeine  (Kapake®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol and codeine  (Solpadol®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol and codeine  (Tylex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol and dihydrocodeine  (Co-dydramol®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol and dihydrocodeine  (Remedeine®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Paracetamol and methionine  (Pardote®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Pentazocine

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Pethidine

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Non Formulary
 
Controlled Drug  Pethidine Hydrochloride and promethazine  (Pamergan® P100)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sumatriptan  (Imigran®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sumatriptan  (Imigran® Radis)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Tapentadol  (Palexia®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Targinact (Oxycodone/Naloxone)  (Targinact®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary

NHS England Guidance for CCGs4:

    • prescribers in primary care should not initiate oxycodone and naloxone combination product for any new patient.
    • prescribers should be supported in deprescribing oxycodone and naloxone combination product in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change.if, in exceptional circumstances, there is a clinical need for oxycodone and naloxone combination product to be prescribed in primary care, this should be undertaken in a cooperation arrangement with a multi-disciplinary team and/or other healthcare professional.No routine exceptions have been identified. 

 

 
Tramadol Hydrochloride  (Dromadol®SR)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tramadol Hydrochloride  (Larapam® SR)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tramadol Hydrochloride  (Zamadol®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tramadol Hydrochloride  (Zamadol® SR)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tramadol Hydrochloride  (Zydol®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tramadol Hydrochloride and paracetamol  (Tramacet®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary

NHS England Guidance for CCGs:

  • prescribers in primary care should not initiate paracetamol and tramadol combination product for any new patient.
  • prescribers should be supported in deprescribing paracetamol and tramadol combination product in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change.

 

No routine exceptions have been identified.

 
Tramadol MR

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tramadol oral drops

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs which require special consideration. These are drugs for Consultant Prescribing ONLY. They should not be prescribed in Primary Care.  

Amber

Drugs that should be initiated by a Specialist but are suitable for continuation in Primary Care. For some drugs there may be a Ricad in place to aid the transition to primary care.  

Amber E

Drugs that should be initiated by a Specialist but are suitable for continuation in Primary Care but also require and ESCA (Shared Care Agreement)   

Green

Suitable first-line drugs for implementation in Primary Care  

On Formulary

South Staffs Formulary Choice  

netFormulary