Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
4. Central nervous system

4.9. Drugs used in parkinsonism and related disorders

4.9.1. Dopaminergic drugs used in Parkinson’s disease

Preferred List
CO-BENELDOPA

Prescribing Notes:

This medicine commonly causes confusion and is best avoided (especially in the elderly).

BNF Link

CO-CARELDOPA (tablets, modified-release tablets)

Prescribing Notes:

The BNF notes that the total daily dose of the carbidopa proportion of these products should be at least 70mg.

BNF Link

Total Formulary
Specialist Only
CO-CARELDOPA (intestinal gel)

Restrictions: Restricted to specialist use only for the treatment of advanced levodopa-responsive Parkinson's disease with severe motor fluctuations and hyper-/dyskinesia when available combinations of Parkinson medicinal products have not given satisfactory results.

BNF Link

CO-CARELDOPA WITH ENTACAPONE (tablets)

Prescribing Notes:

The current preferred brand of carbidopa with entacapone and levodopa is Stanek®

BNF Link

Specialist and GP
AMANTADINE

Restrictions: Restricted to specialist initiation only.

BNF Link

Specialist and GP
SELEGILINE

Restrictions: Restricted to specialist initiation only.

Prescribing Notes:

The selegiline melt formulation remains non-formulary.

BNF Link

ENTACAPONE
Specialist and GP
ROTIGOTINE (TRANSDERMAL PATCH)

Restrictions: Restricted to specialist initiation for patients where the transdermal route would facilitate treatment. Treatment for moderate to severe idiopathic Restless Leg Syndrome (RLS) in adults is restricted to patients with a baseline score of 15 points on the International Restless Legs Scale (IRLS) and who do not respond to or tolerate oral preparations.

BNF Link

Specialist and GP
ROPINIROLE

Restrictions:

Restricted to use on the advice of consultants with a special interest in Parkinson’s disease or movement disorders. Use in restless legs syndrome is restricted to those patients with severe RLS symptoms resulting in significant disruption to sleep and impairment of daily living.

Prescribing Notes:

The preferred brand of modified-release ropinerole in NHSGGC is Ipinnia XL®

BNF Link

Specialist and GP
PRAMIPEXOLE

Restrictions: The use in Parkinson’s disease is restricted to use on the advice of consultants with a special interest in Parkinson’s disease or movement disorders. The use of pramipexole in restless legs syndrome (RLS) is restricted to those patients with severe RLS (symptoms resulting in significant disruption to sleep and impairment of daily living.

Prescribing Notes:

Pramipexole dosing can be expressed as either base or salt and this should be clearly documented when prescribing.

BNF Link

PERGOLIDE
CABERGOLINE
BROMOCRIPTINE
Specialist and GP
APOMORPHINE

Restrictions: Restricted to specialist initiation. Apomorphine is restricted to use in patients with mid/late stage Parkinson’s disease under consultant supervision only.

BNF Link

4.9.2. Antimuscarinic drugs used in parkinsonism

Total Formulary
Specialist and GP
PROCYCLIDINE HYDROCHLORIDE

Restrictions: Restricted to specialist initiation

BNF Link

ORPHENADRINE
TRIHEXYPHENIDYL

4.9.3. Drugs used in essential tremor, chorea, tics, and related disorders

Total Formulary
Specialist Only
BOTULINUM TOXIN B

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
BOTULINUM TOXIN A

Restrictions:

Restricted to specialist use only. It remains non-formulary for the indications detailed in the prescribing notes below.

Prescribing Notes:

Three brands available (Dysport®, Xeomin® and Botox®). The doses are specific to the preparations and they are not interchangeable. Prescribe by brand name.

For uses in urology, see the entry in section 7.4.2 and for use in migraine see section 4.7.4.2

 

The following indications are not recommended for use in NHS Scotland by the SMC and remain non-Formulary:

  • Treatment of focal lower limb spascticity associated with stroke
  • Treatment of focal spasticity of lower limbs due to traumatic brain injury (Dysport®)
  • For cosmetic reasons (e.g. temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown)

BNF Link

Specialist and GP
TETRABENAZINE

Restrictions: Restricted to specialist initiation only.

BNF Link

Specialist and GP
SULPIRIDE

Restrictions: Restricted to specialist initiation only.

BNF Link

Specialist and GP
RILUZOLE

Restrictions: Restricted to specialist initiation only.

BNF Link

Specialist and GP
PRIMIDONE

Restrictions: Restricted to specialist initiation only.

BNF Link

Specialist and GP
PIMOZIDE

Restrictions: Restricted to specialist initiation only.

BNF Link

Specialist and GP
HALOPERIDOL

Restrictions: Restricted to specialist initiation only.

BNF Link

Specialist and GP
CHLORPROMAZINE

Restrictions: Restricted to specialist initiation only.

BNF Link

PROPRANOLOL

4.9.4. Other CNS drugs

Total Formulary
Specialist Only
BOTULINUM TOXIN A (XEOMIN) (injection)

Restrictions:

Restricted to specialist use for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults.

Prescribing Notes:

For other uses of botulinum toxin A, see other Formulary entries.

BNF Link

Specialist Only
INOTERSEN (TEGSEDI) (injection)

Restrictions:

The treatment of hereditary transthyretin-mediated amyloidosis (hATTR amyloidosis) in adult patients with stage 1 or stage 2 polyneuropathy is restricted to specialist use only on the advice of the National Amylodosis Centre.

BNF Link

Specialist Only
PATISIRAN (ONPATTRO) (infusion)

Restrictions:

The treatment of hereditary transthyretin-mediated amyloidosis (hATTR amyloidosis) in adult patients with stage 1 or stage 2 polyneuropathy is restricted to specialist use only on the advice of the National Amylodosis Centre.

BNF Link