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 Formulary Chapter 4: Central nervous system - Full Chapter
04.01.01  Expand sub section  Hypnotics
 note 

Non Pharmacological treatment should always be the first line choice for any sleep intervention/management

Herbal alternatives are available from retail outlets.

Sleep hygiene/ stimulant control advice can be found at the below websites.                                           https://www.nhs.uk/Livewell/insomnia/Pages/bedtimeritual.aspx 

https://patient.info/health/insomnia -poor-sleep

Items should not be put on repeat if possible and reviewed regularly

Hypnotics should be used with caution in the elderly.

Older people can become ataxic, confused and are at increased risk of falls. Where clinically indicated the lowest possible dose should be used for the shortest duration. Other drugs given concomitantly that can increase falls risks should be considered before prescribing

Melatonin
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Formulary
Red

Secondary care only

Unlicensed use

Circadin (GREEN+) if used in line with license - adult aged 55 years and over for upto 13 weeks.

 
Link  PrescQIPP Melatonin Bulletin
Link  PrescQIPP Newly licensed melatonin products
04.01.01  Expand sub section  Benzodiazepines
 note 

Lowest dose and shortest duration of treatment should be used.

Individuals should be advised on the risks of dependence, and advised not to use every night.

Individuals should also be advised of drugs and driving guidance - blood concentration limits set for certain drugs MHRA DSU 2015

 

 

Controlled Drug Temazepam
(hypnotic)
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Third Choice
Green
 
Nitrazepam
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Restricted Drug Restricted
GP - Grey

Individuals currently receiving nitrazepam may be continued due to prolonged use.

Reduction with the aim to withdraw should be discussed where possible. If withdrawal is not possible due to dependence, reduction to minimal dose is advised.

New patients should not be initiated unless under psychiatry.

 
04.01.01  Expand sub section  Zaleplon, Zolpidem and Zopiclone
 note 

Lowest dose and shortest duration of treatment should be used.

Preferably 7 days only and started at the lowest dose. (licensed for max of 28 days use)

Individuals should be advised on the risks of dependence, and advised not to use every night.

 

Zopiclone
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First Choice
Green
 
Zolpidem
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Second Choice
Green
 
Link  NICE TA77: Zaleplon, zolpidem and zopiclone for the management of insomnia
04.01.01  Expand sub section  Antihistamines
 note 

Some sedating antihistamines are useful as alternatives to other hypnotics.

Their sedation properties can aid sleep and can be used for occasional relief from insomnia. There are options availble OTC which can be purchased

The drowsiness effect can run over to the next day and dry mouth is a common side effect, along with other antimuscarinic side effects.

Sedative effect can diminish with prolonged use so advise individuals to use intermittently before stepping up treatment to a Z hypnotic or Benzodiazepine.

Promethazine Hydrochloride
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First Choice
Green
 
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Drugs that may be initiated, stabilised and maintained by primary, secondary or tertiary care Secondary and tertiary care prescribing may be continued by primary care. [this does not indicate first/second line choice]  

Green Hospital

Items used by the Hospital but would not normally be continued into primary care. Primary care prescribers can change to GREEN first or second.   

Green plus

Initiation of drugs by primary care following written advice from secondary/ tertiary care advice.  

Yellow

Drugs that may be continued in primary care following initiation and stabilisation in secondary/tertiary care  

Amber

Items requiring a shared care agreement. These items should be initiated and stabilised by secondary or tertiary care. The GP should only be asked to take over prescribing through a formal shared care agreement. Secondary care will be expected to continue prescribing until the agreement is made.  

Red

Hospital/ Trust ONLY. These are items the secondary and tertiary care are responsible for prescribing and will need to continue to prescribe for long term maintenance. These items will NOT be prescribed in primary care. But primary care should be informed the patient is receiving these items. This will include NHSE funded items requiring repatriation.  

GP - Black

Items covered by NHSE ‘Should not prescribe in primary care list’ – See CCG policy on Drugs of limited clinical value  

GP - Grey

Grey List: Items covered by NHSE ‘Should not prescribe in primary care list’ that are not to be routinely prescribed but may be suitable in a defined population – See CCG policy on Drugs of limited clinical value  

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