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

4.10. Drugs used in substance dependence

4.10.1. Alcohol dependence

Total Formulary
Specialist Only
DISULFIRAM

Restrictions:

Restricted to specialist use only.

Prescribing Notes:

Consult with your local Alcohol and Drug Recovery Service (ADRS) for details of local arrangements relating to ongoing supply of disulfiram.  ADRS will retain responsibility for ongoing clinical review.

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Specialist Only
NALTREXONE (50mg tablets)

Restrictions:

Restricted to specialist use (Addiction Services) according to local treatment guidelines

Prescribing Notes:

  • Treatment should continue for 6 months, or longer for those benefiting from treatment who are motivated to continue.
  • Treatment with naltrexone should be discontinued after 4 to 6 weeks if drinking persist

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Specialist and GP
ACAMPROSATE

Restrictions:

Restricted to specialist initiation only.

Prescribing Notes:

  • Continue for up to one year, although can be continued when relapse prevention benefit is demonstrated
  • Discontinue if lack of efficacy or full relapse occurs
  • Recommended: Review of alcohol consumption and psychosocial wellbeing every 6 months

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NALMEFENE (SELINCRO) (TABLETS)

Prescribing Notes:

Nalmefene is licensed for the reduction of alcohol consumption in adult patients with alcohol dependence who have a high drinking risk level (DRL), without physical withdrawal symptoms and who do not require immediate detoxification.

Nalmefene should only be initiated if DRL remains high two weeks after an initial assessment and should only be prescribed as part of a full package of care including the provision of continuous psychosocial support by appropriate NHS personnel.  It should also be reviewed regularly. 

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4.10.2. Nicotine dependence

Preferred List
VARENICLINE

Restrictions:

Restricted to use according to local protocol.

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NICOTINE REPLACEMENT THERAPY (NICOTINELL)

Prescribing Notes:

Nicotinell® products (24-hour patch, lozenge or gum) are the nicotine replacement treatments of choice. If dual nicotine replacement is appropriate then a 2nd product should be added to Nicotinell® patches.  If a mini lozenge is required, the first choice is Niquitin Mini®.

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Total Formulary
BUPROPION

4.10.3. Opioid dependence

Preferred List
METHADONE (SOLUTION)

Restrictions: Excludes Eptadone®.

Prescribing Notes:

The solution strength is 1mg/ ml.

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Total Formulary
Specialist and GP
LOFEXIDINE

Restrictions: Restricted to specialist services (Alcohol and Drug directorate and Glasgow Addictions Services).

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BUPRENORPHINE (ESPRANOR) (ORAL LYOPHILISATE)

Restrictions:

Restricted to use by specialist services (GGC Alcohol and Drug Services) in patients in whom methadone is not suitable.

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BUPRENORPHINE (sublingual tablets)

Restrictions:

Restricted to specialist services (GGC Alcohol and Drug Services).

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Specialist Only
BUPRENORPHINE (prolonged-release injection)

Restrictions:

Restricted to use by GGC Alcohol and Drug Services in patients in whom methadone is not suitable and for whom the use of buprenorphine is considered appropriate.

BNF Link