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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 4 - Central nervous system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
04.03.01 Tricyclic and related antidepressant drugs
NICE CG192: Antenatal and postnatal mental health: clinical management and service guidance NICE CG28: Depression in children and young people NICE CG53: Chronic fatigue syndrome / Myalgic encephalomyelitis NICE CG61: Irritable Bowel Syndrome NICE CG90: Depression in adults NICE CG91: Depression with a chronic physical health problem
04.03.01 Tricyclic antidepressants
NICE CG192: Antenatal and postnatal mental health: clinical management and service guidance NICE CG28: Depression in children and young people NICE CG53: Chronic fatigue syndrome / Myalgic encephalomyelitis NICE CG61: Irritable Bowel Syndrome NICE CG90: Depression in adults NICE CG91: Depression with a chronic physical health problem

Amitriptyline

GREEN
Formulary

10mg, 25mg & 50mg Tablets
50mg/5mL Oral solution

 

Off-label use in line with Primary Care Guidelines for the Management of Chronic Non-Cancer Pain in Adults

BNF BNFc SPC

Clomipramine
(For licensed indications (except narcolepsy/cataplexy))

Amber SPA
Formulary

10mg, 25mg & 50mg Capsules

 

 

Entry reviewed: June 2022

BNF BNFc SPC

Clomipramine
(For narcolepsy and cataplexy)

SCG
Formulary

10mg, 25mg & 50mg Capsules

 To be used in line with EoE PAC guidance for narcolepsy and cataplexy. Refer to Shared Care Guideline associated with sleep centre attended by the patient.

 

Entry reviewed: June 2022

BNF BNFc SPC

Imipramine 10mg, 25mg
(Tablets)

Amber SPA
Restricted Drug Restricted

For initiation by Mental Health specialist from ELFT only. 

BNF BNFc SPC

Lofepramine

Amber SPA
Formulary

70mg Tablets

BNF BNFc SPC

Nortriptyline

Amber SPA
Restricted Drug Restricted
10mg & 25mg Tablets

Restricted - To be initiated by pain specialists only, where amitriptyline has effectively controlled the neuropathic pain but the patient is intolerant to the side effects.

BNF BNFc SPC
Non formulary items

Dosulepin

DNP
Non Formulary

In line with NHS England » Items which should not routinely be prescribed in primary care: policy guidance

  •  Dosulepin should not be switched to or started because evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose.
  • Dosulepin should not be used as an anxiolytic, for neuropathic pain or for its sedative effects as an aid to sleep.
  • Ensure that prescribing of antidepressants is in line with the relevant NICE clinical guideline.
  • Commence new patients on first line SSRIs (generic citalopram or sertraline), where possible.
  • Review all patients prescribed dosulepin for suitability for switching to a safer antidepressant or suitable agent.
  • For patients under the care of a relevant specialist, involve them in the decision to discontinue or switch treatment.
  • Dosulepin should not be stopped abruptly unless serious side effects have occurred. Slowly tapering the dose over three to four weeks can help prevent discontinuation symptoms.

Entry checked : July 2025

BNF BNFc SPC

Trimipramine (Surmontil®)

DNP
Non Formulary

In line with NHS England » Items which should not routinely be prescribed in primary care: policy guidance

 

Entry checked: July 2025

BNF BNFc SPC
04.03.01 Related antidepressants
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.