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4.1 Hypnotics and anxiolytics

4.1 Hypnotics and anxiolytics

4.1 HYPNOTICS AND ANXIOLYTICS
         
         4.1.1 Hypnotics - for short term use only 
               Try to avoid. If needed, use for 1-3 days only. Do not give on discharge from hospital. Hypnotics are only licensed for short                 term use. On specialist advice only, some patients with long term psychiatric problems may require long term use.
                   GREEN      Temazepam 
                                      tablets 10mg 
                                      elixir 10mg/5mL
                   AMBER      Nitrazepam
                                      tablets 5mg
                                      oral suspension 2.5mg/5mL
                   GREEN       Zopiclone tablets 3.75mg, 7.5mg  
                   GREEN       Zolpidem tablets 5mg, 10mg - in line with NICE TA 77- short term use only. 
                   RED           Melatonin 2mg MR tablets - for use in ICU only
                   RED           Promethazine tablets 10mg, 25mg, liquid 5mg/5mL
 
              Chloral Hydrate for paediatric sedation
                    RED           Chloral hydrate liquid 500mg/5mL
 
               Melatonin [Circardin® tablets]  - See Shared Care Guideline 
               Melatonin PR tablets, off license use, for the treatment of sleep disorders in children aged 2 - 18 years with 
               neurodevelopmental disorders. 
               The long term safety and efficacy of melatonin is unclear. 
                    AMBER Shared Care     Melatonin 2mg [Circardin® prolonged release tablets] [off label use]
 
               Melatonin in the Treatment of Rapid Eye Movement [REM] Sleep Behaviour Disorder [RBD] in Parkinson's Disease and 
               Lewy Body Dementia
               Melatonin prolonged release tablets [Circardin®] are suitable for prescribing in primary care following initiation or 
               recommendation by a specialist when clonazepam is not considered appropriate. 
                    AMBER         Melatonin prolonged release tablets 2mg  [Circardin®]
 
 
               Sodium oxybate for treatment of narcolepsy with cataplexy in adults (under expert supervision)
                     RED              Sodium oxybate 500mg/mL oral solution [Xyrem®]
                                          Specialist medicine
 
 
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         4.1.2 Anxiolytics 
             Use at lowest dose for shortest time possible. Long term use should be avoided except on specialist advice.  
             Chlordiazepoxide is also used in a reducing dose regimen for the management of acute alcohol withdrawal. 
                    GREEN      Chlordiazepoxide
                                       capsules 5mg, 10mg
                    GREEN      Diazepam
                                       tablets 2mg, 5mg, 10mg 
                                       syrup 2mg/5mL
                                       injection 10mg/2mL
                                       suppositories 10mg
                    GREEN      Lorazepam tablets 1mg 
                    RED           Lorazepam injection 4mg/mL
 
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