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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
04.08  Expand sub section  Antiepileptics
04.08.01  Expand sub section  Control of epilepsy
 note 

Category

Antiepileptic drugs

MHRA Advice

1

phenytoin, carbamazepine, phenobarbital, primidone

For these drugs, doctors are advised to ensure that their patient is maintained on a specific manufacturer’s product

2

valproate, lamotrigine, perampanel, retigabine, rufinamide, clobazam, clonazepam, oxcarbazepine, eslicarbazepine, zonisamide, topiramate

For these drugs, the need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history

3

levetiracetam, lacosamide, tiagabine, gabapentin, pregabalin, ethosuximide, vigabatrin  

For these drugs, it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product unless there are specific reasons such as patient anxiety and risk of confusion or dosing errors

BRIVARACETAM (Briviact®)
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Formulary
Amber

Brivaracetam 10mg tablets
Brivaracetam 25mg tablets
Brivaracetam 50mg tablets
Brivaracetam 75mg tablets
Brivaracetam 100mg tablets
Brivaracetam 10mg/ml oral solution
Brivaracetam 50mg/5ml solution for injection vials

For adjunctive therapy in the treatment of partial onset seizures with or without secondary generalisation in adult, adolescent and paediatric patients from 4 years of age with severe refractory epilepsy warrenting epilepsy specialist input who have

  1. Tried 3 or more antiepileptic medications, and
  2. Have used Levetiracetam and has documented intolerance, and would not be suitable for other 3rd line agents; and
  3. Is currently on a 3rd line agent which would be replaced by Brivaracetam: or
  4. Has 3 or more antiepileptic medications and has insufficient symptom control and requires rapid attainment of therapeutic levels.

Restriction: For initiation and stabilisation by a specialist
Unnecessary to maintain patient on specific manufacturer's products.

After stabilisation, primary care may continue its prescribing on receipt of Specialist Clinic patient-specific letter which must include:

  • The previous antiepileptic medications tried
  • Intolerance to Levetiracetam
  • An improvement in side effects after switching from Levetiracetam to Brivaracetam
 
   
Controlled Drug Cannabidiol (Epidyolex®)
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Formulary
Red
High Cost Medicine
NHS England

Restriction: In line with NICE Guidance only

  • For treating seizures associated with Lennox-Gastaut syndrome [adjunctive treatment with clobazam] specialist use only
  • For treating seizures associated with Dravet syndrome [adjunctive treatment with clobazam] specialist use only
 
Link  NICE TA614: Cannabidiol with clobazam for treating seizures associated with Dravet syndrome
Link  NICE TA615: Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome
   
Lacosamide  (Vimpat ® )
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Formulary
Amber

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products

 
   
04.08.01  Expand sub section  Carbamazepine and Oxcarbazepine
Carbamazepine
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Formulary
Amber

Prescribe by Brand

Drug choice for simple/partial seizures and tonic clonic seizures.
Start low dose (100-200mg daily) and build up every two weeks.

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products.

 

 
Link  UKMI Q&A: Why is there a limit on the dose and duration of use for carbamazepine suppositories?
   
Eslicarbazepine (Zebinix®)
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Formulary
Red

Eslicarbazepine 200mg tablets
Eslicarbazepine 800mg tablets

Restriction: By specialist only
Unnecessary to maintain patient on specific manufacturer's products.

 
   
Oxcarbazepine (Trileptal®)
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Formulary
Amber

Oxcarbazepine Tablet 150mg
Oxcarbazepine Tablet 300mg
Oxcarbazepine Tablet 600mg
Oxcarbazepine Oral Suspension 300mg/5ml

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products.

 
   
04.08.01  Expand sub section  Ethosuximide
Ethosuximide
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Formulary
Green

Ethosuximide Oral Solution 250mg/5ml
Ethosuximide Capsule 250mg

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.

 
   
04.08.01  Expand sub section  Gabapentin and pregabalin to top
Controlled Drug Gabapentin
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Formulary
Green

Gabapentin Capsule 100mg
Gabapentin Capsule 300mg
Gabapentin Capsule 400mg

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

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.

 
   
Controlled Drug Pregabalin
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Formulary
Amber

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 Solution 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

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.

 
   
04.08.01  Expand sub section  Lamotrigine
Lamotrigine
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Formulary
Amber

Lamotrigine Tablet 25mg
Lamotrigine Tablet 50mg
Lamotrigine Tablet 100mg
Lamotrigine Tablet 200mg
Lamotrigine Tablet Dispersible 5mg S/F
Lamotrigine Tablet Dispersible 25mg S/F
Lamotrigine Tablet Dispersible 100mg S/F

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.

 
   
04.08.01  Expand sub section  Levetiracetam
Levetiracetam
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Formulary
Amber

Levetiracetam Tablet 250mg
Levetiracetam Tablet 500mg
Levetiracetam Tablet 750mg
Levetiracetam Tablet 1g
Levetiracetam Oral Solution 500mcg/5ml S/F

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.

 
   
04.08.01  Expand sub section  Phenytoin
Phenytoin
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Formulary
Amber

Phenytoin Sodium Capsule 25mg
Phenytoin Sodium Capsule 50mg
Phenytoin Sodium Capsule 50mg
Phenytoin Sodium Capsule 100mg
Phenytoin Sodium Capsule 300mg
Phenytoin Oral Liquid

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products.

 
Link  UKMI Q&A: Information on change of phenytoin capsules to tablets and vice versa
   
04.08.01  Expand sub section  Tiagabine
Tiagabine (Gabitril®)
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Formulary
Amber

Tiagabine Tablet 5mg
Tiagabine Tablet 10mg
Tiagabine Tablet 15mg

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.

 
   
04.08.01  Expand sub section  Topiramate to top
Topiramate
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Formulary
Amber

Topiramate Tablet 25mg
Topiramate Tablet 50mg
Topiramate Tablet 100mg
Topiramate Tablet 200mg

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.

 
   
04.08.01  Expand sub section  Valproate
Sodium Valproate
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Formulary
Amber

Sodium Valproate Tablet 100mg
Sodium Valproate Tablet 300mg M/R
Sodium Valproate Tablet 500mg M/R
Sodium Valproate Tablet E/C 200mg
Sodium Valproate Tablet E/C 500mg
Sodium Valproate Oral Solution 200mg/5ml S/F

Restriction: Initiation and stabilisation by specialist
Maintain patient on specific manufacturer's products.

Please see the following links to materials to support the new Valproate Pregnancy Prevention Programme:

Patient Card – to be given by pharmacists to all female patients who are dispensed valproate medicines to inform them of the risks
Patient Guide – to be provided to girls (of any age) and women of childbearing potential (or their parent/caregiver/responsible person) taking any medicine containing valproate
Guide for healthcare professionals – for all prescribers, pharmacists, and other healthcare providers involved in the care of women and girls of childbearing potential using valproate medicines
• Risk Acknowledgment form – for the specialist and patient (or their parent/caregiver/responsible person) to sign at initiation and at treatment reviews at least every year. The patient should receive a copy of the form; one copy should be filed in the specialist notes, and one copy sent to the patient’s GP

 
Link  Medicines related to valproate: risk of abnormal pregnancy outcomes
Link  MHRA Guidance : Stronger advice on the use of valproate medicines in women
   
04.08.01  Expand sub section  Vigabatrin
Vigabatrin (Sabril®)
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Formulary
Amber E

Vigabatrin Tablet 500mg
Vigabatrin Powder Sachet 500mg S/F

Supported by ESCA only where agreed from initiating trust (see links below)

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products

 
Link  ESCA: Birmingham and surrounds
Link  ESCA: Children with epilepsy (for DTHFT only)
   
04.08.01  Expand sub section  Zonisamide
Zonisamide
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Formulary
Amber E

Zonisamide 25mg capsules
Zonisamide 50mg capsules
Zonisamide 100mg capsules

Should be initiated by a specialist and suitable for continuation in primary care with ESCA - see link below

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products

 
Link  Birmingham ESCA
   
04.08.01  Expand sub section  Other Drugs
Perampanel (Fycompa®)
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Formulary
Red

Perampanel 2mg tablets
Perampanel 4mg tablets
Perampanel 6mg tablets
Perampanel 8mg tablets
Perampanel 10mg tablets
Perampanel 12mg tablets

Restriction: By specialist only
Unnecessary to maintain patient on specific manufacturer's products.

 
Link  NICE CG137: The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care
   
Retigabine
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Formulary
Amber

Retigabine Tablet 50mg
Retigabine Tablet 100mg
Retigabine Tablet 200mg
Retigabine Tablet 300mg
Retigabine Tablet 400mg

Retigabine for the adjunctive treatment of partial onset seizures in epilepsy, see TA232.

Discontinued June 2017See manufacturer's note

 
Link  NICE TA232: Retigabine for the adjunctive treatment of adults with partial onset seizures in epilepsy with and without secondary generalisation
   
Rufinamide (Inovelon®)
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Formulary
Amber

Rufinamide Tablet 100mg
Rufinamide Tablet 200mg
Rufinamide Tablet 400mg
Rufinamide Oral Suspension 40mg/1ml S/F

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products

 
   
04.08.02  Expand sub section  Drugs used in status epilepticus to top
Clonazepam
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Formulary
Amber

Clonazepam Tablets 500mcg
Clonazepam Tablets 2mg
Oral solution 500mcg/5ml
Oral Solution 2mg/5ml 
 
 

 

 
   
Diazepam Rectal Tubes
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Formulary
Green
Diazepam Solution 2.5mg/1.25ml Rectal Tube
 
   
Controlled Drug Midazolam (Buccolam)
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Formulary
Green
Buccolam Pre-filled Syringe 0.5ml(2.5mg)
Buccolam Pre-filled Syringe 1ml(5mg)
Buccolam Pre-filled Syringe 1.5ml(7.5mg)
Buccolam Pre-filled Syringe 2ml(10mg)

Only Licensed for patients between 3 months and 18 years of age.

No Licensed Preparation for over 18 year olds. Preferred prescribe Buccolam off label


 
   
04.08.03  Expand sub section  Febrile convulsions
 ....
 Non Formulary Items
Acetazolamide

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Non Formulary
 
Ethosuximide  (Emeside®)

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Non Formulary

prescribe generically-note liquid cheaper then capsules

Restriction: Initiation and stabilisation by specialist
Unnecessary to maintain patient on specific manufacturer's products.

 
Fosphenytoin Sodium  (Pro-Epanutin®)

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Non Formulary
 
Lamotrigine  (Lamictal®)

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Non Formulary
 
Paraldehyde

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Non Formulary
 
Controlled Drug  Phenobarbital

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Non Formulary
 
Phenytoin  (Epanutin®)

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Non Formulary
 
Phenytoin Sodium  (Epanutin® Ready Mixed Parenteral)

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Non Formulary
 
Sodium Valproate  (Epilim® Intravenous)

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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