nhs forth valley formulary 11 - Community Pharmacy

Forth Valley Formulary Eleventh Edition 2012/13Chapter/Section/Drug Primary Care AcutePage 21CHPsMentalHealthSpecialtiesServices4.6 Drugs used in Nausea & VertigoHaloperidol (palliative care) (see section 4.2) Levomepromazine [Methotrimeprazine] (palliative care) (see section 4.2)Cinnarizine Cyclizine Inj ( oral use in paediatrics and adolescents in acute trust)Prochlorperazine (2 nd Line) Domperidone (1 st Line) Metoclopramide Ondansetron (Restricted – oncology & anaesthetics)Fosaprepitant (Ivemend®) Restricted use West of Scotland Cancer NetworkHyoscine Hydrobromide Betahistine4.7 AnalgesicsComment Refer to Primary Care Guidance on Use of Oral Analgesics (Appendix 7) and also to Forth ValleyPalliative Care Guidelines and Specialist FormularyRefer to Guidance on Pain Management in a Person with a Substance Misuse Problem (In-Patient)4.7.1 Non-opioid AnalgesicsParacetamol (1 st Line) Co-codamol 8/500Co-codamol 30/500 Comment N.B. increased opioid side-effects and risk of dependence with co-codamol.Also, effervescent preparations of compound analgesics may contain high levels of sodium.For patients requiring low sodium intake please refer to individual Summary of Product Characteristics.Refer also to Primary Care Guidance on Use of Oral Analgesics (Appendix 7) andAcute Pain Service Guideline for In-patient Acute Pain (Appendix 9)4.7.2 Opioid AnalgesicsDihydrocodeine Morphine Diamorphine Comment Morphine to be used first line over DiamorphineCyclimorph® Fentanyl Patch–(Prescribe by brand–Matrifen®) Fentanyl [Fentanyl Injection for Acute Services refer to section 15.1.4.3]Comment Fentanyl indicated if unacceptable toxicity from morphine.Fentanyl Patch indicated for patient with severe pain with swallowing difficulties or intractable nauseaand vomiting. (SIGN 106 – Control of Pain in Adults withCancer)Refer to manufacturers information for oral morphine to transdermal route conversion –conversion ratios vary, so should be used only as an initial approximate guide.Oxycodone (Palliative care and specialist pain management only)Comment To convert oral morphine to oral oxycodone divide total 24 hours dose of morphine by 2 to determinethe total dose of oxycodone in 24 hours4.7.3 Neuropathic PainAmitriptyline [see section 4.8] (1st Line) Gabapentin [see section 4.8] (2 nd Line) Comment Refer to Local Neuropathic Pain Guidelines (Appendix 8)Carbamazepine (see section 4.8) Epilim® (see section 4.8) 4.7.4 Antimigraine DrugsSumatriptan (1 st Line) Rizatriptan Pizotifen