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).
Non-formulary
Medicines removed from the formulary:
psychotropic
Benperidol -July 2100
medicines
Benzatropine -July 2011
Agomelatine
Chloral hydrate -Nov 2009
Asenapine
Dosulepin (Dothiepin) -2007
Duloxetine
Droperidol -2001
Escitalopram
Nefazodone -January 2003
Olanzapine palmoate melatonin (Unlicensed) –July 2011
Oxazepam
Most recent full review of the formulary: September 2012
Reboxetine -July 2011
Risperidone long-acting injection - April 2011
Ritalin-SR -July 2011
Thioridazine - 2005
Zotepine - July 2011
Further advice & Information
 Details of the formulary process may be found in TWC21c, applications forms for non-formulary medicines for specific patients (SDTC2)
or application forms for inclusion of a medicine in the formulary (SDTC1) may be found on 'Quick'.
 Trust Prescribing protcols and advice may be found on the Pharmacy Services mini site and the Policies section of 'Quick'.
 Please refer to the latest BNF / Summary of Product Characteristics for detailed prescribing information.
 See the BNF, BNFc and Manufacturers Summary of Product Characteristics for full prescribing details.
 Contact your local Mental Health Pharmacist or Medicines Information on 020 3513 6829 for help and advice.
DTC September 2012
NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
3.4.1 Sedating antihistamines
Medicine
Formulations
Alimemazine tartrate
liquid 30mg / 5ml
(Trimeprazine tartrate)
 Promethazine
tablet 10mg, 25mg
hydrochloride
liquid 5mg / 5ml
4.1 Hypnotics & Anxiolytics
Nitrazepam
tablet 5mg,
liquid 2.5mg / 5ml
Temazepam
tablets 10mg, 20mg
liquid 10mg / 5ml
Non-benzodiazepine hypnotics & other sedatives
Zopiclone
tablet 3.75mg
tablet 7.5mg
Clomethiazole(previously
capsule 192mg,
chlormethiazole)
liquid 250mg / 5ml
Melatonin
Tablets 2mg MR (Circadin®)
4.1.2 Anxiolytics
Diazepam
Chlordiazepoxide
Lorazepam
DTC September 2012
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 (unavailable),
2mg/1ml (does NOT require
dilution)*
Restrictions
Additional information
See CAMHS rapid tranquillisation
 BNF: “less suitable for prescribing”
See Trust policy TWC21x
Use with caution & at lower dosage in the
elderly (see BNF)
Store in Controlled Drugs Cupboard
See Trust policy TWC21x
Note: BNF maximum dosage is 7.5mg
Note: 1 capsule = 5ml liquid
School-age children
with developmental
disability.
Unlicensed may continued in those already
taking this and cannot have Circadin®.
Unlicensed melatonin prescriptions should
be sent to a Hospital Pharmacy.
Injection (emulsion) intravenous (IV) only
For alcohol
detoxification regimens
only
IM gluteal injection only
4mg/1ml injection: dilute 1:1 with water for
injection / sodium chloride 0.9%
*Imported from outside the EU.
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
Formulations
Restrictions
Chlorpromazine
tablet 10mg, 25mg,
50mg, 100mg
liquid 25mg/5ml,
100mg/5ml
Flupentixol
3mg tablet
dihyrochloride
Haloperidol
capsule 500microg,
MHRA warning: pre-treatment
tablet 1.5mg, 5mg, 10mg
ECG required
liquid 5mg/5ml, 10mg/5ml
injection 5mg/1ml
 Promazine
liquid 25mg / 5ml
See BNF for licensed
tablet 25mg, 50mg
indications
Sulpiride
tablet 200mg, 400mg
liquid 200mg / 5ml
Trifluoperazine
tablet 1mg, 5mg**
liquid 5mg/5ml
Zuclopenthixol acetate injection 50mg, 100mg
(“Clopixol Acuphase”)
Zuclopenthixol
tablet 2mg,10mg, 25mg
dihydrochloride
Atypical Antipsychotics
Amisulpride
tablet 50mg, 200mg, 400mg
liquid 100mg / 1ml
Aripiprazole
tablet 5mg, 10mg, 15mg
Not 1st line for any indication
orodisp tab. 10mg, 15mg
Max recommended 10injection 7.5mg in 1ml
15mg/day in schizophrenia
Clozapine
tablet 25mg, 100mg
See TWC21c
(Zaponex)
liquid 50mg/mL
(Denzapine)
DTC September 2012
See Trust policy TWC21c.
NOT to be used for night sedation.
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
 BNF: “less suitable for prescribing”
**Manufacturing delays frequent consider
switching to another medicine.
Not for rapid tranquillisation
Monitoring systems used: Zaponex Treatment
Access System (ZTAS) for tablets. Denzapine
Monitoring service (DMS) for liquid.
NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
Medicine
Olanzapine
Formulations
tablet 2.5mg, 5mg, 7.5mg,
10mg, 15mg, 20mg
dispers. tablet 5mg, 10mg,
15mg
injection 10mg/2ml
tablet 25mg, 100mg, 150mg,
200mg, 300mg
M/R tablets 50mg, 200mg,
300mg, 400mg
Risperidone (oral) 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
As per the Trust Rapid
Tranquillisation guidelines
Quetiapine
DTC September 2012
1st line atypical antipsychotic
Orodispersible for dyspahgia or
supervised administration only
Additional information
Max 3 days ‘in an episode’
NOT within 2 hours of IM lorazepam
Limited supply -discontinued
Requires twice daily dosage
For community team use for supervised
administration.
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
Complete monitoring form before prescribing.
Complete SDTC2 if patient does not meet Trust
prescribing criteria.
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
Formulations
“Priadel” tablet MR
200mg, 400mg
liquid 10.8mmol Li /
5ml (“Li-liquid”)
tablet e/c 250mg,
500mg
Valproic Acid
(as semisodium valproate)
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
Reversible MAOIs
Moclobemide
tablet 150mg
DTC September 2012
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
Prescribe as “Depakote – semisodium valproate” to
avoid confusion with Epilim
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”
Not first-line treatment
NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
4.3.3 Selective serotonin re-uptake inhibitors
Medicine
Formulations
Prescribing
restrictions
Additional information
Citalopram
tablet 10mg, 20mg
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,
Not first-line
45mg
treatment
Venlafaxine
tablet 37.5mg, 75mg
Not first-line MR = modified release, used where immediate release
caps. MR 75mg, 150mg
treatment
is not tolerated or poor compliance
4.4 Central Nervous System Stimulants and other Medicines used for attention deficit hyperactivity disorder See TWC21s
Atomoxetine
capsule 10mg, 18mg, 25mg, 40mg,
CAMHS use Third line, after methylphenidate and dexamfetamine
60mg
Dexamfetamine sulphate
tablet 5mg
CAMHS use Controlled Drug
Methylphenidate hydrochloride tablet 5mg, 10mg
CAMHS use Controlled Drug
Methylphenidate hydrochloride Concerta , Equasym , Medikinet XL
CAMHS use Controlled Drug 1st line preparation
4.8 Antiepileptics (treatment / prevention of psychiatric symptoms)
Carbamazepine
tablet 100mg, 200mg, 400mg
Licensed for “prophylaxis of bipolar disorder not
tablet MR 200mg, 400mg
responsive to lithium.”
liquid 100mg / 5ml
Recommended in NICE Bipolar guideline
Clonazepam
tablet 500microgram, 2mg
Use other than for epilepsy is an unlicensed indication
Lamotrigine
tablet 25mg, 50mg, 100mg, 200mg
Use other than for epilepsy is an unlicensed indication
dispers. tab. 5mg, 25mg, 100mg
Recommended in NICE bipolar guideline
Midazolam
buccal liquid 10mg / 1ml
“Specials”
Available for conscious sedation according to Trust
product
guidelines for its use
Pregabalin
Capsules 25mg, 100mg, 300mg
in line with NICE, initiation form to be completed.
Sodium valproate
tablet 100mg, 200mg, 500mg
1st line
Endorse with ‘Epilim’ to avoid prescribing and
tablet MR 200mg, 300mg, 500mg
valproate
administration errors.
liquid 200mg / 5ml
preparation
DTC September 2012
NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
4.9 Medicines used in parkinsonism and related disorders
4.9.2 Antimuscarinic Medicines used in parkinsonism
Medicine
Formulations
Prescribing
restrictions
Orphenadrine
tablet 50mg
liquid 50mg / 5ml
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
Opioid dependence
Buprenorphine
tablet sublingual 8mg,
Initiation by Addictions
2mg & 400microgram
teams only
Buprenorphine/ Tablets
Initiation by Addictions
naloxone
2mg/500microrams
teams only
Substitution treatment for
8mg/2mg
opiod dependence in the
framework of medical
psychological and social
treatment for patients over
15yrs who have agreed to
treatment.
Lofexidine
tablet 200micrograms
Methadone
liquid “mixture” 1mg
/1ml (sugar free)
tablet 50mg
Naltrexone
DTC September 2012
Additional information
Manufacturing delays frequent consider switching to another medicine.
See blue book
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
Initiation by Addictions
teams only
Controlled Drug
Initiation by Addictions
teams only
NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information
Medicine
4.11 Medicines for dementia
Donepezil
Galantamine
Formulations
Prescribing restrictions
tablet 5mg, 10mg
orodisp tablet 5mg,
10mg
tablet 4mg, 12mg
Older peoples & LD teams
only
Rivastigmine
capsule 1.5mg
liquid 2mg / 1ml
patch
4.6mg/24hours &
9.5mg /24 hours
Memantine
Tablet 10mg, 20mg
Liquid 5mg/pump
9.6.7 Multivitamin preparations
Sanatogen Gold
tablet
1.3.2 Selective antimuscarinics
Pirenzapine
Tablet 50mg
DTC September 2012
Additional information
See TWC21q
In accordance with local protocols
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
Eating disorders inpatient
service only
For use alongside an emergency diet in patients at
risk of re-feeding syndrome
In accordance with local protocols
Antipsychotic induced
See Trust ‘off-label’ list appendix 1 of TWC21k.
sialorrhoea resistant to other Imported from within the EU.
antimuscarinic medicines
NOTE: The formulary is continually updated – contact the Pharmacy Department for current formulary information