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 Formulary Chapter 4: Central nervous system - Full Chapter
04.07.02  Expand sub section  Opioid analgesics
Codeine Phosphate
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First Choice Tablets
Oral liquid 
Controlled Drug Morphine
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First Choice Oral solution:
  • 10mg/5mL
  • 100micrograms/mL (unlicensedunlicensed)

    Concentrated oral solution:
  • 100mg/5mL

    Tablets

    M/R 12-hourly oral preparations:
  • Zomorph capsules
  • MST tablets

    M/R 24-hourly oral preparations:
  • MXL capsules

    Suppositories

    Injection

    PCA syringe (unlicensedunlicensed)

     
  • Controlled Drug Tapentadol (Palexia)
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    Third Choice
    Grey

    Prolonged-release tablets


    Tablets


    Oral solution



    • Third or fourth line option in those patients who have failed other therapies and are intolerant to oxycodone.

    • To be prescribed or initiated under the advice of a specialist in pain management only.

      Grey Traffic Light Use of this agent should be restricted to those patients requiring treatment of severe chronic pain which CANNNOT be managed with more established opioid therapies.

     
    Link  GMMMG recommendation: Tapentadol for treatment of severe pain
    Link  MHRA Safety Alert: risk of seizures and reports of serotonin syndrome
       
    Controlled Drug Buprenorphine
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    Formulary Patches (BuTrans or Transtec)
    S/L tablets (Temgesic
       
    Controlled Drug Diamorphine
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    Formulary Injection 
       
    Dihydrocodeine
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    Formulary Tablets
    M/R tablets 
       
    Controlled Drug Fentanyl
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    Formulary Patches
    Restricted Item Buccal tablets (Effentora) Palliative care only
    Restricted Item Nasal spray (PecFent) Palliative care only
     
    Link  GMMMG IPNTS Recommendation: Fentanyl preparations
    Link  MHRA Safety Alert: Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure
       
    Controlled Drug Oxycodone
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    Formulary Immediate-release preparations (OxyNorm):
  • Oral solution 5mg/5mL
  • Concentration oral solution 10mg/mL
  • Capsules
  • Injection

    M/R preparations (OxyContin):
  • Tablets 
  •    
    Controlled Drug Pethidine
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    Formulary Tablets
    Injection 
       
    Controlled Drug Tramadol
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    Formulary Capsules
    Soluble tablets
    M/R tablets or capsules
    Injection 
    Link  UKMI Q&A: risk of developing Serotonin Syndrome following concomitant use of tramadol with SSRIs
       
     ....
     Non Formulary Items
    Controlled Drug  Fentanyl  (Actiq®)

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    Non Formulary
     
    Controlled Drug  Fentanyl  (Instanyl nasal spray)

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    Non Formulary
     
    Controlled Drug  Fentanyl sublingual tablets  (Abstral)

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    Non Formulary
     
    Controlled Drug  Hydromorphone  (Palladone)

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    Non Formulary
     
    Meptazinol  (Meptid)

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    Non Formulary
     
    Controlled Drug  Morphine and cyclizine  (Cyclimorph)

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    Non Formulary
     
    Controlled Drug  Papaveretum

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    Non Formulary
     
    Controlled Drug  Pentazocine

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

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    Non Formulary
     
    Controlled Drug  Targinact (Oxycodone/Naloxone)

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    Non Formulary
    Link  GMMMG Recommendation: Targinact
     
    Tramadol Hydrochloride and paracetamol  (Tramacet)

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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

    Amber

    Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

    Black

    These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

    Green

    Not used   

    Green 1

    Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

    Green 2

    Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

    Green 3

    Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

    Grey

    Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

    Red

    Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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