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4.2.1 Antipsychotics

4.2.1 Antipsychotic drugs   
Link to Suggested Monitoring Requirements of High Risk Drugs
Used for conditions such as schizophrenia or in the short term to calm disturbed patient. Other less common uses are: treatment of nausea and vomiting, choreas, motor tics and intractable hiccup. Benperidol is specifically used for deviant antisocial sexual behaviour, to be initiated by a consultant.    
RED                     Benperidol 
                           tablets 250mcg  
Pronounced sedative effects    
GREEN              Chlorpromazine 
                           tablets 10mg, 25mg, 50mg, 100mg
                           syrup 25mg/5mL ,  syrup 100mg/5mL  
GREEN                Promazine   
                           tablets 25mg, 50mg     
                           oral solution 25mg/5mL
                           oral solution 50mg/5mL  
Fewer sedative effects  
GREEN              Haloperidol 
                           tablets 1.5mg, 5mg, 10mg 
                           capsules 500 micrograms
                           oral liquid 2mg/mL    
                           injection 5mg/mL
GREEN              Sulpiride tablets 200mg   
AMBER             Flupentixol dihydrochloride 
                           tablets 3mg 
AMBER             Trifluoperazine  
 (LCFT)               tablets 1mg, 5mg
                           oral solution 5mg/5mL 
AMBER             Zuclopenthixol dihydrochloride 
                           tablets 2mg, 10mg
RED                   Zuclopenthixol acetate 
 (LCFT)               injection 50mg/mL

Atypical antipsychotics 

To be started by specialists only.
A shared care protocol is also available which outlines both the specialists and the GPs responsibilities - click here to access it. 
Quetiapine XL formulation  
The Drugs & Therapeutics Committee reviewed the current activity on the prescribing of the prolonged release form of Quetiapine. This formulation was approved by D&T in March 2009 subject to a prescribing guideline and initiation by a consultant. In light of the dramatic increase in the use of this product the D&T committee have made the decision to introduce an approval process. Quetiapine will become generic in 2012 and the current position regarding this formulation is unclear but it may be available as a generic product. This will place a significant cost burden on our primary care colleagues which in the current economic climate is open to challenge.
SHARED CARE    Amisulpride 
                              tablets 50mg, 200mg   
                              liquid 100mg/mL    
SHARED CARE    Aripiprazole tablets 10mg, 15mg, 30mg (consultant initiation only)   
SHARED CARE    Aripiprazole orodispersible tablets 10mg, 15mg (for use only when swallowing difficulties) 
RED                      Aripiprazole tablets 10mg, 15mg, 30mg 
                             (consultant use only for alternating hemiplegia)  
RED                      Clozapine tablets 25mg, 100mg (consultant only)  
SHARED CARE    Olanzapine tablets 2.5mg, 5mg, 7.5mg, 10mg, 15mg  
                              oro-dispersible 5mg, 10mg
RED                      Olanzapine  injection 5mg/mL        
SHARED  CARE   Quetiapine    
                              tablets 25mg, 100mg, 150mg, 200mg   
                              m/r tablets 50mg, 200mg, 300mg, 400mg
                              m/r tablets to be prescribed by brand.
                              Formulary choices are Zaluron XL tablets, Sondate XL tablets
SHARED CARE    Risperidone
                              tablets 500 micrograms,1mg, 2mg, 3mg, 4mg 
                              Quicklets® 500 micrograms, 1mg, 2mg
                              liquid 1mg/mL    
SHARED CARE     Zotepine tablets 25mg, 50mg 100mg (consultant initiation only) 
SHARED CARE     Cariprazine [Reagila®]
                              capsules 1.5mg, 3mg, 4.5mg, 6mg
                              [Only to be used as second-line therapy (where clozapine is not appropriate] where predominantly negative 
                              symptoms have been identified as an important feature - See Shared Care Guideline]
RED                       Lurasidone (Latuda®) 
                              tablets fc 18.5mg, 37mg, 74mg
                              Specialist service use only
  Click here for the New Medicine Recommendation for Lurasidone

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public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service 
 Email: info.elmmb@nhs.net
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