4.2.1. Antipsychotic drugs
The initiation of antipsychotics would usually be under the guidance of a specialist who may base selection on a wide range of factors.Prescribing Notes:
If haloperidol is not considered appropriate, other antipsychotics from the Total Formulary may be considered.
Prescribing Notes:
Preferred choice for adult patients <65 years of age. If risperidone is not considered appropriate, other atypical antipsychotics from the Total Formulary may be considered.
Restrictions:
Restricted to initiation by a consultant psychiatrist with the injection being further restricted to use by consultant psychiatrists only. The treatment of moderate to severe manic episodes in bipolar 1 disorder and the prevention of a new manic episode in patients who experienced predominantly manic episodes is non-Formulary. Treatment of schizophrenia in adolescents 15 years and older is restricted to the initiation and management under the supervision of a child/ adolescent psychiatrist.
Restrictions:
Use in the treatment of schizophrenia in adults is restricted to second-line therapy in patients where predominantly negative symptoms have been identified as an important feature.
Restrictions:
Consultant only. Patients must be registered with a Clozapine patient monitoring scheme.
Restrictions:
Restricted to psychiatrist initiation in accordance with local protocol as an alternative treatment option in patients in whom it is important to avoid weight gain and metabolic adverse effects.
The local protocol specifies that lurasidone be:
- For first-line presentation psychosis only: use as a first-line treatment of schizophrenia where aripiprazole or olanzapine are not suitable
- For adults aged 18 years and above with an establised diagnosis of schizophrenia: use as a third-line treatment option where aripiprazole has been ineffective and weight gain and metabolic adverse effects are to be minimised.
Restrictions:
Restricted to initiation by clinicians experienced in the treatment of psychosis. The injection is restricted to use when oral therapy is not suitable. CSM have advised that there is an increased risk of stroke in elderly patients with dementia treated with olanzapine. The long-acting injection (ZypAdhera) for maintenance treatment of schizophrenia has not been accepted for use by the SMC and is non-Formulary.
Restrictions:
Restricted to initiation by consultant psychiatrist and the Prescribing Notes below.
Prescribing Notes:
Immediate-release tablets are Formulary for:
- Schizophrenia
- Bipolar disorder:
- Treatment of moderate to severe manic episodes in bipolar disorder.
- Prevention of recurrence in patients with bipolar disorder, in patients whose manic episode has responded to quetiapine treatment
Indications not recommended by SMC and therefore non-Formulary are:
- Treatment of major depressive episodes in bipolar disorder.
- Prevention of recurrence in patients with bipolar disorder, in patients whose depressive episode has responded to quetiapine treatment.
- Add-on treatment of major depressive episodes in patients with Major Depressive Disorder (MDD) who have had sub-optimal response to antidepressant monotherapy (applicable to MR tablets only)
Quetiapine prolonged-release preparations are not included in the GGC Adult Formulary.