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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
04.04 CNS stimulants and other drugs used for attention deficit hyperactivity disorder
ADHD/Hyperkinetic Disorder for Children & Young People (6-17 years) – Shared care agreement: Methylphenidate, Atomoxetine, Dexamfetamine, Lisdexamfetamine and Guanfacine NICE NG87 Attention deficit hyperactivity disorder: diagnosis and management The management of Attention-deficit hyperactivity disorder (ADHD) in Adults Shared Care Guideline (ELFT)

Atomoxetine

SCG
Formulary

For ADHD: Follow SCGs 

 

Link to Shared Care protocols

The management of Attention-deficit hyperactivity disorder (ADHD) in adults – Shared care guideline – BLMKICB Medicines Optimisation

BLMK Shared-care-agreement-for-the-treatment-of-attention-deficit-hyperactivity-disorder-adhd-in-children-young-people-6-17-years

 

 

Entry reviewed: September 2024

BNF BNFc SPC
MHRA Drug Safety Update (January 2012) - Atomoxetine: increases in blood pressure and heart rate

Dexamfetamine

SCG
Formulary

For ADHD: Follow SCGs 

 

Link to Shared Care protocols

The management of Attention-deficit hyperactivity disorder (ADHD) in adults – Shared care guideline – BLMKICB Medicines Optimisation

BLMK Shared-care-agreement-for-the-treatment-of-attention-deficit-hyperactivity-disorder-adhd-in-children-young-people-6-17-years

 

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

Entry reviewed: June 2022

BNF BNFc SPC

Guanfacine (Intuniv®)

SCG
Formulary

For ADHD: Follow SCGs 

 

Link to Shared Care protocols

The management of Attention-deficit hyperactivity disorder (ADHD) in adults – Shared care guideline – BLMKICB Medicines Optimisation

BLMK Shared-care-agreement-for-the-treatment-of-attention-deficit-hyperactivity-disorder-adhd-in-children-young-people-6-17-years

 

Entry reviewed: Septemeber 2024 

BNF BNFc SPC

Lisdexamfetamine (Elvanse®)

SCG
Formulary

For ADHD: Follow SCGs 

 

Link to Shared Care protocols

The management of Attention-deficit hyperactivity disorder (ADHD) in adults – Shared care guideline – BLMKICB Medicines Optimisation

BLMK Shared-care-agreement-for-the-treatment-of-attention-deficit-hyperactivity-disorder-adhd-in-children-young-people-6-17-years

 

Entry reviewed: September 2024

BNF BNFc SPC

Methylphenidate 5mg, 10mg & 20mg
(Tablets)

SCG
Formulary

For ADHD: Follow SCGs

 

Link to Shared Care protocols

The management of Attention-deficit hyperactivity disorder (ADHD) in adults – Shared care guideline – BLMKICB Medicines Optimisation

BLMK Shared-care-agreement-for-the-treatment-of-attention-deficit-hyperactivity-disorder-adhd-in-children-young-people-6-17-years

 

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

Entry reviewed: June 2022

BNF BNFc SPC

Methylphenidate Hydrochloride MR

SCG
Formulary

For ADHD: Follow SCGs (See below).

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

 

Link to Shared Care protocols

The management of Attention-deficit hyperactivity disorder (ADHD) in adults – Shared care guideline – BLMKICB Medicines Optimisation

BLMK Shared-care-agreement-for-the-treatment-of-attention-deficit-hyperactivity-disorder-adhd-in-children-young-people-6-17-years

 

NB: Modified release tablets and modified release capsules  are not interchangeable as there can be differences in ratios of immediate -release/extended-release components between individual formulations and brands.

Modified release tablets

  • Preferred brand in BLMK is Xaggitin XL® - available as 18mg, 27mg, 36mg and 54mg strengths.
  • In times of supply shortages, the modified release tablets can be prescribed generically.
  • The following brands are regarded as being bioequivalent as they have the same immediate release / extended release profile of 22:78: Xaggitin XL® ; Affenid XL® ; Delmosart XL® ; Matoride XL® ; Xenidate XL® ; Concerta XL®

Modified release capsules

  • The following brands of modified capsules are available: Medikinet XL® ; Metyrol XL® ; Equasym XL®, Ritalin XL®, Meflynate XL®.
  • Modified release capsules must be prescribed by brand name as different brands have different release profiles and are NOT bioequivalent.

          Click here for information regarding the different release profiles of the various different brands of biphasic  methylphenidate modified release products (tablets and capsules).

Entry reviewed: January 2025

BNF BNFc SPC
MHRA DSU Sept 2022: Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations

Modafinil tablets

SCG
Formulary

Refer to Shared Care Guideline associated with sleep centre attended by the patient.

 

Entry reviewed: January 2025

BNF BNFc SPC
MHRA Drug Safety Update (November 2020): increased risk of congenital malformations if used during pregnancy Modafinil (Provigil): now restricted to narcolepsy

Solriamfetol (Sunosi®)
(75 mg and 150 mg film-coated tablets)

RED
Restricted Drug Restricted

Restricted for use in accordance with NICE TA 758

FOR ALL PRESCRIBING -Blueteq or High cost drug form required - see link from Formulary homepage

BNF BNFc SPC BlueTeq
NICE TA 758 Solriamfetol for treating excessive daytime sleepiness caused by narcolepsy
04.04 Cocaine
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.