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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
04.07.04.02 Prophylaxis of migraine
BLMK Migraine Prevention Pathway in Adults (Specialist use only) Oxygen and triptans for cluster headaches December 2021

Pizotifen

GREEN
Formulary

500microgram Tablets
1.5mg Tablets

NB: Tablets can be crushed and dispersed to aid swallowing / facilitate tube administration.

 

 

Entry reviewed: March 2024

BNF BNFc SPC

Atogepant (Aquipta®)
(10mg & 60mg tablets)

Amber SPIS
Restricted Drug Restricted

Approved for use in line with NICE TA973 for preventing migraine in adults who have at least 4 migraine days per month.

Specialist to initiate and prescribe for the first 12 weeks and carry out the 12 week review. Blueteq or high cost drug form required - see link from formulary homepage. Continuation in primary care thereafter for patients with an adequate response.

 

Entry reviewed: July 2024

BNF BNFc SPC BlueTeq
NICE TA973: Atogepant for preventing migraine

Clonidine

GREEN
Formulary
25microgram Tablets
BNF BNFc SPC

Eptinezumab (Vyepti®)
(100 mg concentrate for solution for infusion)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING - Blueteq or high cost drug form required - see link from formulary homepage.

To be used in accordance with the following NICE TA(s):

BNF BNFc SPC BlueTeq
NICE TA871: Eptinezumab for preventing migraine

Erenumab (Aimovig®)
(70mg and 140mg solution for injection in pre-filled syringe or pre-filled pen)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING - Blueteq or high cost drug form required - see link from formulary homepage.

To be used in accordance with the following NICE TA(s):

BNF BNFc SPC
NICE TA 682 Erenumab for preventing migraine

Fremanezumab 225 mg (Ajovy®)
(Pre-filled Pen for Injection)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING - Blueteq or high cost drug form required - see link from formulary homepage.

For use in accordance with the following TA(s) only:

BNF BNFc SPC
NICE TA 764 Fremanezumab for preventing migraine

Galcanezumab 120mg in 1mL (Emgality®)
(Pre-filled Pen for Injection)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING - Blueteq or high cost drug form required - see link from formulary homepage

For use in accordance with the following NICE TA(s) only:-

BNF BNFc SPC
NICE TA 659 Galcanezumab for preventing migraine

Propranolol

GREEN
Formulary

10mg, 40mg & 80mg Tablets
80mg, 160mg MR Tablets
10mg in 5mL Sugar-Free Solution
50mg in 5mL Sugar-Free Solution

Migraine prophylaxis: 80–240 mg daily in divided doses

BNF BNFc SPC

Rimegepant 75 mg oral lyophilisate (Vydura®)
(Treatment of migraine)

GREEN
Restricted Drug Restricted

May be prescribed in any care setting for treating migraine, in accordance with the recommendations in NICE TA919:

Rimegepant is recommended as an option for the acute treatment of migraine with or without aura in adults, only if for previous migraines:

  • at least 2 triptans were tried and they did not work well enough or

  • triptans were contraindicated or not tolerated, and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.

Entry reviewed: July 2024

BNF BNFc SPC
BLMK ICB: Rimegepant for Acute Treatment of Migraine With or Without Aura in Adults. NICE TA906: Rimegepant for preventing migraine NICE TA919: Rimegepant for treating migraine

Rimegepant 75 mg oral lyophilisate (Vydura®)
(prevention of migraine)

Amber SPIS
Restricted Drug Restricted

Specialist to initiate and prescribe for the first 12 weeks for the prevention of migraine (NICE TA906) and carry out the 12 week review. Blueteq or high cost drug form required - see link from formulary homepage. Continuation in primary care thereafter for patients with an adequate response.

Entry reviewed: July 2024

BNF BNFc SPC
BLMK ICB: Rimegepant for Acute Treatment of Migraine With or Without Aura in Adults. NICE TA906: Rimegepant for preventing migraine NICE TA919: Rimegepant for treating migraine

Topiramate

Amber SPA
Restricted Drug Restricted

25mg, 50mg & 100mg Tablets

15mg 25mg and 50mg Sprinkle Capsules - may be swallowed whole or opened and sprinkled on a teaspoon of soft food (must be swallowed immediately and not chewed).

Topiramate must no longer be prescribed to women and girls unless they fulfil the requirements of a Pregnancy Prevention Programme.

Entry reviewed August 2024

BNF BNFc SPC
Annual Risk Awareness Form - Topiramate PPP in prophylaxis of migraine MHRA: Topiramate (Topamax): safety measures and Pregnancy Prevention Programme Patient guide on Topiramate Pregnancy Prevention Programme Prescriber Guide on Topiramate Pregnancy Prevention Programme in prophylaxis of migraine

Botulinum Toxin Type A (botox®)

RED
Restricted Drug Restricted

Restricted - to be initiated under Consultant authorisation and in accordance with NICE TA260

Must be prescribed by brand name

BNF BNFc SPC
NICE TA260: Botox for migraine prophylaxis
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.