NHS Logo
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
04.07.02 Opioid analgesics
MHRA Drug Safety Update: Opioids: risk of dependence and addiction (Sept 2020) NICE CG140: Opioids in palliative care NICE NG59: Low back pain and sciatica in over 16s: assessment and management Prescribing for Palliative patients (L&D) Prolonged-release opioids: Removal of indication for relief of post-operative pain RCGP Top Tips for Dependence Forming Medications (2019)

Morphine Sulphate
(Injection)

GREEN
First Choice

10mg/1mL, 15mg/1mL, 30mg/1mL

100mg/50mL IV Infusion

10mg/10ml preservative free

BNF BNFc SPC

Morphine Sulphate 10mg/ 5mL (Oramorph®)
(Oral Solution)

GREEN
First Choice
First choice strong opiate.
BNF BNFc SPC

Morphine Sulphate MR (Zomorph®)
(Modified Release Capsules)

GREEN
First Choice
10mg, 30mg, 60mg & 100mg Sustained Release capsules

First choice strong opiate.



BNF BNFc SPC

Oxycodone 10mg, 20mg, 40mg, 80mg Modified Release Tablets
(Analgesia)

GREEN
Restricted Drug Restricted

Restricted - 2nd-line use. Only to be prescribed if morphine sulphate is not suitable. Prescribe as a regular dose.

Current cost-effective brand in Primary care: Oxypro®

 

BNF BNFc SPC
Discharge Medication for Enhanced Recovery Patients Following Primary Hip and Knee Arthroplasty

Oxycodone 5mg/ 5mL
(Oral Solution)

GREEN
Restricted Drug Restricted
Restricted - for inpatient use only. Usually for ’prn’ use with regular oxycodone MR tablets.
For 2nd-line use only, where morphine sulphate is not appropriate or tolerated.

N.B. Must change to immediate release capsules on discharge if still required.
BNF BNFc SPC

Oxycodone
(Injection)

Amber SPA
Restricted Drug Restricted
10mg/1mL Injection
 
Restricted - Only to be prescribed 2nd line, if morphine sulphate is not suitable appropriate or tolerated.

50mg/1mL Injection - Ordered on a named patient basis only. Write patient's name and hospital number in CD order book.
BNF BNFc SPC

Oxycodone 5mg, 10mg
(Capsules)

GREEN
Restricted Drug Restricted
Restricted - not for in-patient use. For 2nd-line use only, where morphine sulphate is not appropriate or tolerated.
Usually prescribed for ’prn’ dose e.g for enhanced recovery patients on discharge following knee or hip arthroplasty.

When prescribing this product on TTA's and outpatient prescriptions, the quantity to be supplied must be stated in words and figures and countersigned in order to fulfill the legal requirements of controlled drug prescriptions.
BNF BNFc SPC
Discharge Medication for Enhanced Recovery Patients Following Primary Hip and Knee Arthroplasty

Buprenorphine 200microgram, 400microgram
(Sublingual Tablets)

Amber SPA
Formulary

When prescribing this product on TTA's and outpatient prescriptions, the quantity to be supplied must be stated in words and figures and countersigned in order to fulfill the legal requirements of controlled drug prescriptions. e.g. Please supply Five (5) tablets (signed).

BNF BNFc SPC
NICE TA114: Methadone and buprenorphine for the management of opioid dependence

Buprenorphine 35, 52.5, 70 microgram
(96 hour transdermal patches)

GREEN
Formulary
Releasing 35micrograms per hour, 52.5micrograms per hour or 70micrograms per hour over 96 hours.For convenience of use, this can be changed twice a week at regular intervals.

When prescribing this product on TTA's and outpatient prescriptions, the quantity to be supplied must be stated in words and figures and counter signed in order to fulfil the legal requirements of controlled drug prescriptions. e.g. Please supply Four (4) patches (signed).
N.B. pack size is 4 patches.
BNF BNFc SPC
NICE TA114: Methadone and buprenorphine for the management of opioid dependence

Buprenorphine 7 day transdermal patch
(7 day transdermal patch)

GREEN
Formulary

When prescribing this product on TTA's and outpatient prescriptions, the quantity to be supplied must be stated in words and figures and counter signed in order to fulfil the legal requirements of controlled drug prescriptions. e.g. Please supply two (2) patches (signed)

Preferred brand in Primary Care is Sevodyne

Available strengths: 5, 10, 15 and 20 micrograms/hr

 

Entry reviewed: September 2023

BNF BNFc SPC

Codeine 15mg, 30mg
(Tablets)

GREEN
Formulary
BNF BNFc SPC
MHRA Drug Safety Update (July 2013) -Codeine for analgesia: restricted use in children because of reports of morphine toxicity MHRA Drug Safety Update (June 2013) - Codeine: restricted use as analgesic in children and adolescents after European safety review

Diamorphine 5mg, 10mg, 30mg, 100mg, 500mg
(Injection)

GREEN
Formulary
Higher strengths (100mg & 500mg) ordered on a named patient basis only. Write patient's name and hospital number in CD order book.
BNF BNFc SPC

Dihydrocodeine 30mg
(Tablets)

GREEN
Formulary
BNF BNFc SPC

Dihydrocodeine 60mg m/r tablets (DHC Continus®)

RED
Restricted Drug Restricted

Approved for use as part of the C-section pathway only

BNF BNFc SPC

Fentanyl 72 hour Transdermal Patch

Amber SPA
Formulary

Releasing 12microgram, 25microgram, 37.5micrograms, 50microgram, 75microgram & 100microgram per hour over 72 hours.

When prescribing this product on TTA's and outpatient prescriptions, the quantity to be supplied must be stated in words and figures and counter signed in order to fulfil the legal requirements of controlled drug prescriptions. e.g. Please supply Five (5) patches (signed).

N.B. pack size is 5 patches.

 

Current preferred brand in Primary Care is FENCINO®

Entry updated November 2024

BNF BNFc SPC
MHRA Drug Safety Update (July 2014) - Transdermal fentanyl “patches”: reminder of potential for life-threatening harm from accidental exposure, particularly in children MHRA Drug Safety Update: Transdermal fentanyl patches for non-cancer pain: do not use in opioid-naive patients (Sept 2020) MHRA DSU Oct 2018: Transdermal fentanyl patches: life-threatening and fatal opioid toxicity from accidental exposure, particularly in children

Fentanyl Buccal tablets (Effentora® )

RED
Formulary

Restricted Item Restricted to initiation by palliative care team only.

Buccal Tablets - various strengths

Not to be prescribed on TTA's. Not recommended by NHS England » Items which should not routinely be prescribed in primary care: policy guidance

 

Entry reviewed: July 2025

BNF BNFc SPC

Meptazinol (Meptid®)
(Tablets)

GREEN
Formulary
200mg Tablets
BNF BNFc SPC

Morphine 100 micrograms/ml oral

RED
Restricted Drug Restricted

For use in NICU patients only on safety grounds. DTC August 2024

BNFc SPC

Morphine Sulphate (MST Continus®)
(Sustained Release Tablets)

GREEN
Formulary
5mg, 15mg sustained release tablets
BNF BNFc SPC

Morphine Sulphate (Sevredol®)
(Tablets)

GREEN
Formulary
N.B. these are not sustained release and should be prescribed every 4 to 6 hours like Oramorph.
BNF BNFc SPC

Morphine Sulphate 100mg/ 5mL
(Concentrated oral solution)

GREEN
Formulary

When prescribed at BHFT use only under the direction of the specialist palliative care team

BNF BNFc SPC

Morphine sulphate orodispersible tablets (Actimorph®)

GREEN
Formulary

 

 

Entry reviewed: June 2022

BNF BNFc SPC

Pethidine
(Injection)

RED
Formulary
50mg/1mL Injection
100mg/2mL Injection
BNF BNFc SPC

Tramadol
(Oral)

GREEN
Formulary
50mg Capsules
50mg Soluble Tablets

When prescribing this product on TTA's and outpatient prescriptions, the quantity to be supplied must be stated in words and figures and counter signed in order to fulfil the legal requirements of controlled drug prescriptions. e.g. Please supply thirty (30) capsules (signed).
BNF BNFc SPC
Warfarin: be alert to the risk of drug interactions with tramadol

Tramadol
(Injection)

RED
Formulary
100mg/2mL Injection
BNF BNFc SPC

Tramadol MR tablets

GREEN
Formulary

50mg, 100mg, 150mg, 200mg MR tabs 

 

 Marol is the preferred cost-effective brand in Primary Care

 

NB: MR capsules carry a high cost-pressure and should not be prescribed.

 

Entry reviewed: April 2023

BNF BNFc SPC
Warfarin: be alert to the risk of drug interactions with tramadol

Oxycodone 10mg, 20mg, 40mg, 80mg Modified Release Tablets
(Enhanced recovery protocol (Hospital))

RED
Restricted Drug Restricted

 

ENHANCED RECOVERY


Restricted - to initiation by Anaesthetics team and continuation by the Pain team and ward surgical and orthopaedic doctors, for pain management in enhanced recovery for hip and knee arthroplasty surgical patients, in accordance with Enhanced Recovery protocol (see link below). Maximum 5 days in total.

When prescribing this product on TTA's and outpatient prescriptions, the quantity to be supplied must be stated in words and figures and counter signed in order to fulfil the legal requirements of controlled drug prescriptions. e.g. Please supply twenty eight (28) tablets (signed).

BNF BNFc SPC
Discharge Medication for Enhanced Recovery Patients Following Primary Hip and Knee Arthroplasty
Non formulary items

Dipipanone

DNP
Non Formulary

Now de-branded (from Diconal) and costs about £400 for 50.

BNF BNFc SPC

Fentanyl Lozenges (Actiq®, Cynril®)

 
Non Formulary

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

 

Entry checked: July 2025

BNF BNFc SPC

Oxycodone/Naloxone (Targinact®) (Tablets)

DNP
Non Formulary

Trial period has expired. No good evidence to support this drug - do not prescribe. Not prescribable in Primary care.

 

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

 

Entry checked: July 2025

BNF BNFc SPC

Tramadol Hydrochloride and paracetamol (Tramacet®)

DNP
Non Formulary

Fixed dose combination of 37.5mg tramadol plus 325mg paracetamol is no more effective than established analgesics in acute or chronic pain, contains a sub-therapeutic amount of paracetamol and is more expensive than alternatives.

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

 

Entry checked: July 2025

BNF BNFc SPC
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.