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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
04.07.03 Neuropathic pain
NICE CG173: Neuropathic pain in adults: pharmacological management in non-specialist settings NICE NG59: Low back pain and sciatica in over 16s: assessment and management RCGP Top Tips for Dependence Forming Medications (2019)

Amitriptyline

GREEN
Formulary

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

 

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

BNF BNFc SPC

Carbamazepine
(For neuropathic pain)

GREEN
Formulary

100mg & 200mg Tablets
125mg & 250mg Suppositories
200mg & 400mg Sustained Release Tablets
100mg/5mL Suspension

Suppositories of 125 mg may be considered to be approximately equivalent in therapeutic effect to tablets of 100 mg but final adjustment should always depend on clinical response (plasma concentration monitoring recommended).

BNF BNFc SPC

Duloxetine 30mg, 60mg
(Capsules)

GREEN
Formulary

Licensed for diabetic neuropathy

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

 

NB: The 90mg and 120mg are high cost NON FORMULARY strengths.

NB: The 20mg and 40mg are only licensed for stress incontinence and are Non-Formulary for the above indication.

Entry reviewed: July 2024

BNF BNFc SPC
INTERIM BLMK Primary Care Guidelines for the Management of Chronic Non-Cancer Pain in Adults

Gabapentin

GREEN
Formulary

100mg, 300mg & 400mg Capsules

Ensure loading regime is prescribed when initiated therapy for neuropathic pain to reduce side effects. 300mg OD 1/7, 300mg BD 1/7 then 300mg TDS thereafter.

BNF BNFc SPC
DSU Oct 2017: Gabapentin (Neurontin): risk of severe respiratory depression

Gabapentin 250mg/ 5mL
(Oral Solution)

GREEN
Restricted Drug Restricted

Restricted - for adult patients with swallowing difficulties or Paediatric patients only.

For enteral tube administration - open the capsule, dissolve the contents in water, and give immediately.

BNF BNFc SPC
DSU Oct 2017: Gabapentin (Neurontin): risk of severe respiratory depression

Ketamine 50mg/5mL oral solution
(Neuropathic pain (inpatient use))

RED
Formulary

For the treatment of neuropathic pain in inpatients under supervision of pain team at Bedford hospital only.

BNF BNFc SPC

Pregabalin

GREEN
Restricted Drug Restricted

25mg, 50mg, 75, 100mg, 300mg capsules.

Third-line choice for neuropathic pain in accordance with JPC guidance. See link below.

Entry reviewed July 2024

BNF BNFc SPC
Bedfordshire and Luton “Primary Care Guidelines for the Management of Chronic Non-Cancer Pain in Adults guidelines .

Ketamine
(For use within palliative care)

RED
Restricted Drug Restricted

For use by Hospices only in adults in palliative care.

Oral use:

50mg/5mL liquid

 

Subcutaneous use:

10mg/ml x 20ml - NB current national shortage of this strength

50mg/ml x 10ml

 

NB: 100mg/ml x 10 ml discontinued strength

Entry reviewed: May 2025

BNF BNFc SPC
04.07.03 Trigeminal neuralgia
04.07.03 Postherpetic neuralgia
04.07.03 Chronic facial pain
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.