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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 4: Central nervous system - Full Chapter
04.07.04.02  Expand sub section  Prophylaxis of migraine
Amitriptyline
(Migraine prophylaxis)
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Formulary
Green
Unlicensed indication 
   
Botulinum Toxin Type A (botox®)
(Migraine prophylaxis)
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Formulary
Red
High Cost Medicine
Injection
Consultant recommendation only - in line with NICE TA260.
  • For other indications see section 4.9.3
     
  • Link  Link to reviews
       
    Pizotifen
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    Formulary
    Green
    Tablet
  • Elixir discontinued March 2014
  • Unlicensed "Special" liquid can cost £750
  • Tablets disperse well in water 
  •    
    Propranolol
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    Formulary
    Green
     
       
    Topiramate
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    Restricted Drug Restricted
    Amber 3
  • 3rd line option as per Nottinghamshire APC headache guideline
  • GPs may initiate as per Prescribing Guideline 
  •    
     ....
     Non Formulary Items
    Clonidine  (Dixarit®)

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    Non Formulary
    Grey

    Tablet

    GREY for migraine but see GREEN indication for menopausal symptoms

     
    Clonidine oral solution 50micrograms in 5ml

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    Methysergide  (Deseril®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
  • Discontinued Sept 2013
  • Link  MHRA Drug Safety Update (Dec 2014)
     
    Sodium valproate
    (Migraine prophylaxis)

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    Non Formulary
    Grey

    Unlicensed indication.

    • Previously in the Nottinghamshire APC headache guideline but removed in the 2016 review. Current patients should be reviewed by a specialist.
    • Contraindicated in women of childbearing potential unless part of a Pregnancy Prevention Programme. MHRA info
    Link  MHRA Drug Safety Update (April 2017)
    Link  NUH Lite Bite: Valproate in females of or nearing child bearing age.
    Link  Risk Management Material: Information for Women of childbearing potential
    Link  Toolkit: risks of valproate medicines in females
     
      
    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
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    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

    Grey

    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      

    Red

    Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
      

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
      

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      

    Green

    Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.   

    OTC

      

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