Introduction
This Formulary is to detail those psychotropic medicines that may be prescribed within the Trust (on hospital prescriptions and FP10s) and
recommended to be prescribed across South West London. Shared care for Psychotropics with Primary care and the ‘off-label’ policy
should be read in conjunction with the formulary.
The Formulary contains:
 formulations that are available within the Trust
 prescribing restrictions / guidelines that apply to that medicine within the Trust
 additional information pertinent to the safe & effective use of the medicine
 Medicines in the same order as the British National Formulary (BNF), with headings
 Only psychotropic medicines (see local Hospital Formularies for medicines for physical complaints).
 Nicotine replacement treatments follow Wandsworth CCG formulary (includes bupropion and varenacline and other treatments)
Non-formulary psychotropic
medicines
Agomelatine
Aripiprazole depot
Asenapine
Duloxetine
Escitalopram
Loxapine inhalation
Nalmefene
Olanzapine palmoate
Oxazepam
Medicines removed from the formulary:
Droperidol -2001
Nefazodone -January 2003
Thioridazine - 2005
Dosulepin (Dothiepin) -2007
Chloral hydrate -Nov 2009
Benperidol -July 2010
Benzatropine -July 2011
melatonin (Unlicensed) –July 2011
Reboxetine -July 2011
Risperidone long-acting injection - April 2011
Ritalin-SR -July 2011
Zotepine - July 2011
Olanzapine short acting inj. Dec 2013
Orphenadrine Sept 2013
Promazine Dec 2013
Temazepam Feb 2014
Further advice & Information
 Contact your local Mental Health Pharmacist or Medicines Information on 020 3513 6829 for help and advice.
 The Trust intranet has formulary policy (TWC21c), and applications forms for non-formulary medicines for specific patients (SDTC2) or
inclusion in to the formulary (SDTC1) .
 Trust Prescribing protcols and advice may be found on the Pharmacy Services intranet mini site and the Policies section of the intranet
or primary & acute care may find it on the Trust internet pages.
 See the BNF, BNFc and Manufacturers Summary of Product Characteristics for full prescribing details.
DTC May 2014 NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
3.4.1 Sedating antihistamines
Medicine
Formulations
Promethazine hydrochloride
tablet 10mg, 25mg
liquid 5mg / 5ml
injection 25mg/mL
4.1 Hypnotics & Anxiolytics
Nitrazepam
tablet 5mg,
liquid 2.5mg / 5ml
Non-benzodiazepine hypnotics & other sedatives
Zopiclone
tablet 3.75mg
tablet 7.5mg
Zolpidem
Tablet 5mg
Tablet 10mg
Clomethiazole(previously
capsule 192mg,
chlormethiazole)
liquid 250mg / 5ml
Melatonin
Tablets 2mg MR (Circadin®)
4.1.2 Anxiolytics
Diazepam
Chlordiazepoxide
Lorazepam
tablet 2mg, 5mg, 10mg. liquid
2mg/5ml, 5mg/5ml. injection
emulsion 5mg/ml, rectal solution
5mg, 10mg
capsule 5mg, 10mg
tablet 1mg, 2.5mg
injection 4mg / 1ml
Restrictions
Additional information
See Trust policy TWC21x
Use with caution & at lower dosage in the
elderly (see BNF)
See Trust policy TWC21x
1st line
2nd line after zopiclone
Note: 1 capsule = 5ml liquid
School-age children
with developmental
disability.
Unlicensed melatonin prescriptions should
be sent to a Hospital Pharmacy ONLY.
Injection (emulsion) intravenous (IV) only
For alcohol
detoxification regimens
only
4mg/1ml injection: dilute 1:1 with water for
injection / sodium chloride 0.9%
DTC May 2014 NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
4.2 Medicines used in psychoses and related disorders
4.2.1 Antipsychotic Medicines
Medicine
Chlorpromazine
Flupentixol
dihyrochloride
Haloperidol
Sulpiride
Trifluoperazine
Zuclopenthixol acetate
(“Clopixol Acuphase”)
Formulations
tablet 10mg, 25mg,
50mg, 100mg
liquid 25mg/5ml,
100mg/5ml
3mg tablet
capsule 500microg,
tablet 1.5mg, 5mg, 10mg
liquid 5mg/5ml, 10mg/5ml
injection 5mg/1ml
tablet 200mg, 400mg
liquid 200mg / 5ml
tablet 1mg, 5mg**
liquid 5mg/5ml
injection 50mg, 100mg
Zuclopenthixol
tablet 2mg,10mg, 25mg
dihydrochloride
Atypical Antipsychotics
Amisulpride
tablet 50mg, 200mg, 400mg
liquid 100mg / 1ml
Aripiprazole
tablet 5mg, 10mg, 15mg
orodisp tab. 10mg, 15mg
injection 7.5mg in 1ml
Clozapine
tablet 25mg, 100mg (Zaponex)
liquid 50mg/mL (Denzapine)
Restrictions
Pre-treatment ECG required
See Trust policy TWC21c.
NOT to be used for night sedation.
Hospital only: mania in Children
Additional information
Chlorpromazine injection is not available for use
within the Trust, the risk of serious cardiac
effects deemed unsafe by the DTC.
See below for details of haloperidol decanoate
depot injection
**Manufacturing delays frequent, consider
switching to another medicine.
For use in patients requiring
or may require repeated IM
injections and are refusing
oral medicines
Not 1st line for any indication
Max recommended 1015mg/day in schizophrenia
Use liquid only if doses are <2.5mg/day.
Use for antipsychotic induced metabolic disorder
or hyperprolactinaemia must follow Trust policy.
Monitoring systems used: Zaponex Treatment
Access System (ZTAS) for tablets. Denzapine
Monitoring service (DMS) for liquid.
DTC May 2014 NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
Medicine
Olanzapine
Quetiapine
Risperidone (oral)
Formulations
tablet 2.5mg, 5mg, 7.5mg,
10mg, 15mg, 20mg
dispers. tablet 5mg, 10mg,
15mg
tablet 25mg, 100mg, 150mg,
200mg, 300mg
MR tablets 50mg, 200mg,
300mg, 400mg
tablet 500microg, 1mg, 2mg,
3mg, 4mg, 6mg
dispers. tablet 1mg, 2mg, 3mg,
4mg. liquid 1mg / 1ml
4.2.2. Antipsychotic Depot Injections
Flupenthixol
20mg/1ml, 40mg/2ml,
decanoate
50mg/0.5ml, 100mg/1ml,
200mg/1ml.
Fluphenazine
12.5mg/0.5ml, 25mg/1ml,
decanoate
50mg/0.5ml &100mg/1ml
Haloperidol
50mg/1ml, 100mg/1ml
decanoate
Pipothiazine
50mg/1ml, 100mg/2ml
palmitate
Zuclopenthixol
200mg/1ml, 500mg/1ml
decanoate
Paliperidone
50mg, 75mg, 100mg, 150mg
palmoate
Prescribing restrictions
Orodispersible for dyspahgia or
supervised administration only
Additional information
Requires twice daily dosage
For community team use for
supervised administration, not
for discharge.
1st line atypical antipsychotic
Orodispersible for dyspahgia or
supervised administration only
Optimum oral dosage 4-6mg per day in
schizophrenia.
See TWC21b for administration details
Schizophrenia: either side
effects from current depot,
compliance problems with oral
atypical or at patient request.
Not 1st line depot if considered
treatment resistant patient.
Complete monitoring form before prescribing.
Complete SDTC2 if patient does not meet Trust
prescribing criteria.
DTC May 2014 NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
4.2.3 Antimanic Medicines
Medicine
Carbamazepine
Lamotrigine
Sodium valproate
Lithium carbonate
Lithium citrate
Semisodium valproate
Formulations
“Priadel” tablet MR
200mg, 400mg
liquid 10.8mmol Li /
5ml (“Li-liquid”)
tablet e/c 250mg,
500mg
4.3 Antidepressant Medicines
4.3.1Tricyclic & related antidepressant Medicines
Amitriptyline
tablet 10mg, 25mg,
50mg
liquid 50mg / 5ml
Clomipramine
caps 10mg, 25mg,
50mg
Imipramine
tablet 10mg, 25mg
liquid 25mg / 5ml
Lofepramine
tablet 70mg
liquid 70mg / 5ml
Nortriptyline
tablet 10mg, 25mg
Trimipramine
tablet 10mg, 25mg
capsule 50mg
Trazodone
capsule 50mg,100mg
liquid 50mg / 5ml
4.3.2 Monoamine – oxidase inhibitors (MAOIs)
 Phenelzine
tablet 15mg
 Isocarboxazid
tablet 10mg
 Tranylcypromine
tablet 10mg
Prescribing restrictions
Additional information
See Section 4.8 - Antiepileptic Medicines below
See Section 4.8 - Antiepileptic Medicines below
See Section 4.8 - Antiepileptic Medicines below
(MR = modified release)
10.8mmol/5ml = 400mg lithium carbonate
2nd line valproate
preparation after Epilim
Prescribe as “Depakote – semisodium valproate” to
avoid confusion with Epilim (sodium valproate)
Not first-line treatment
Not first-line treatment
Not first-line treatment
Not first-line treatment
 BNF: “less suitable for prescribing”
 BNF: “less suitable for prescribing”
 BNF: “less suitable for prescribing”
DTC May 2014 NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
Reversible MAOIs
Moclobemide
tablet 150mg
Not first-line treatment
4.3.3 Selective serotonin re-uptake inhibitors
Medicine
Formulations
Citalopram
Escitalopram
tablet 10mg, 20mg
Tablet 10mg, 20mg
Prescribing
restrictions
Additional information
For OCD on the
recommendation of the
National OCD service
only. Not for any other
indication.
Fluoxetine
capsule 20mg, liquid 20mg / 5ml
Paroxetine
tablet 20mg, 30mg liquid 10mg / 5ml
Sertraline
tablet 50mg, 100mg
4.3.4 Other antidepressant Medicines
Mirtazapine
orodispersible tablet 15mg, 30mg,
45mg
Venlafaxine
tablet 37.5mg, 75mg (IR)
Not first-line treatment
Immediate release to be used unless
caps. MR 75mg, 150mg
patient chooses or there is a clinical need.
4.4 Central Nervous System Stimulants and other Medicines used for attention deficit hyperactivity disorder See TWC21s
Atomoxetine
capsule 10mg, 18mg, 25mg, 40mg,
Third line, after methylphenidate and
60mg
dexamfetamine
CAMHs or Adult ADHD
Dexamfetamine sulphate
tablet 5mg
Controlled Drug
service only
Methylphenidate hydrochloride tablet 5mg, 10mg
Controlled Drug
Methylphenidate hydrochloride Concerta , Equasym , Medikinet XL
Controlled Drug 1st line preparation
4.8 Antiepileptics (treatment / prevention of psychiatric symptoms)
Carbamazepine
tablet 100mg, 200mg, 400mg
Licensed for “prophylaxis of bipolar
tablet MR 200mg, 400mg
disorder not responsive to lithium.”
liquid 100mg / 5ml
Recommended in NICE Bipolar guideline
Clonazepam
tablet 500microgram, 2mg
Lamotrigine
tablet 25mg, 50mg, 100mg, 200mg
dispers. tab. 5mg, 25mg, 100mg
DTC May 2014 NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
Midazolam
buccal liquid 10mg / 1ml
Pregabalin
Capsules 25mg, 100mg, 300mg
Sodium valproate
tablet 100mg, 200mg, 500mg
tablet MR 200mg, 300mg, 500mg
liquid 200mg / 5ml
4.9 Medicines used in parkinsonism and related disorders
4.9.2 Antimuscarinic Medicines used in parkinsonism
Medicine
Formulations
Prescribing
restrictions
Procyclidine
tablet 5mg
liquid 5mg / 5ml
injection 5mg / 1ml
Trihexyphenidyl tablet 2mg, 5mg
(Benzhexol)
4.10 Medicines used in substance dependence
Alcohol dependence
Acamprosate
tablet 333mg
Initiation by Addictions
teams only
Disulfiram
tablet 200mg
Initiation by Addictions
teams only
Opioid dependence
Available for conscious
sedation according to
Trust guidelines for its
use in intellectual
disability only
in line with NICE for generalised anxiety disorder, initiation form to be
completed. OCD on recommendation of National tertiary service only.
1st line valproate
Endorse with ‘Epilim’ to avoid prescribing
preparation
and administration errors.
Additional information
See blue book & Trust policy
DTC May 2014 NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
Buprenorphine
tablet sublingual 8mg,
2mg & 400microgram
Tablets
2mg/500microrams
8mg/2mg
Initiation by Addictions
teams only
Initiation by Addictions
teams only
Lofexidine
tablet 200micrograms
Initiation by Addictions
teams only
Methadone
liquid “mixture” 1mg
/1ml (sugar free)
tablet 50mg
Buprenorphine/
naloxone
Naltrexone
Medicine
4.11 Medicines for dementia
Donepezil
Galantamine
Rivastigmine
Memantine
Substitution treatment for
opiod dependence in the
framework of medical
psychological and social
treatment for patients over
15yrs who have agreed to
treatment.
Ensure opiate detox brand is used (i.e.not Temgesic analgesic)
Controlled Drug
 Those with a history crushing and injecting tablets
 Known to divert prescribed medication
 Unable to comply with supervised consumption of buprenorphine in
first 3 months of treatment due to work or child care commitments or
physical disability
 Transferred from another service already initiated on Suboxone®.
Controlled Drug
Controlled Drug
Initiation by Addictions
teams only
Formulations
Prescribing restrictions
Additional information
tablet 5mg, 10mg
orodisp tablet 5mg,
10mg
tablet 4mg, 12mg
Older peoples & LD teams
only
See TWC21q
In accordance with local protocols
1st Line
capsule 1.5mg
liquid 2mg / 1ml
patch
4.6mg/24hours &
9.5mg /24 hours
Tablet 10mg, 20mg
Liquid 5mg/pump
Older peoples & LD teams
only
Older peoples & LD teams
only
In accordance with local protocols
Older peoples & LD teams
only
In accordance with local protocols
In accordance with local protocols
DTC May 2014 NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
9.6.7 Multivitamin preparations
Sanatogen Gold
tablet
1.3.2 Selective antimuscarinics
Pirenzapine
Tablet 50mg
Eating disorders inpatient
service only
For use alongside an emergency diet in patients at
risk of re-feeding syndrome
Antipsychotic induced
See Trust ‘off-label’ list appendix 1 of TWC21k.
sialorrhoea resistant to other Imported from within the EU.
antimuscarinic medicines
DTC May 2014 NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information