4.2.1 Antipsychotics drugs

Antipsychotics (first-generation)

Haloperidol
  • Capsules 500 micrograms (£1.18 = 30 capsules)
  • Tablets 1.5mg, 5mg, 10mg, 20mg (£12.95 = 10mg x 28)
  • Oral liquid 5mg/5ml (£6.47 = 100ml)
  • Injection 5mg/ml (£0.87 = ampoule)

Indications

Levomepromazine
  • Tablet 25mg (£20.26 = 84 tablets)
  • Injection 25mg/ml (£2.01 = 1ml ampoule)

Indications

Sulpiride
  • Tablets 200mg, 400mg (£18.80 = 30 x 400mg)
  • Oral solutionSF 200mg/5ml (£27.00 = 150ml)

Indications

Antipsychotics (second-generation)

Amisulpride
  • Tablets 50mg, 100mg, 200mg, 400mg (£16.43 = 400mg daily)
  • Solution 100mg/ml (£36.00 = 60ml)

Indications

Aripiprazole
  • Tablets 5mg, 10mg, 15mg, 30mg (£1.86 = 15mg daily)
  • Orodispersible tablets 10mg, 15mg (£79.57 = 15mg daily)

Indications

Notes

  1. NICE TA213 Schizophrenia - aripiprazole (January 2011)
  2. NICE TA292 Bipolar disorder (adolescents) - aripiprazole (July 2013)
Olanzapine
  • Tablets 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg (£1.05 = 10mg daily)
  • Orodispersible tablets 5mg, 10mg, 15mg, 20mg (£2.26 = 10mg daily)

Indications

Quetiapine
  • Tablets 25mg, 100mg, 150mg, 200mg, 300mg (£3.13 = 400mg daily)
  • Zaluron® XL tablets modified release 50mg, 150mg, 200mg, 300mg, 400mg (£43.87 = 400mg daily)

Indications

Notes:

  1. Quetiapine modified release tablets should only be used when individuals cannot tolerate immediate-release or if concordance with a twice daily regimen is difficult.
Risperidone
  • Tablets 500 micrograms, 1mg, 2mg, 3mg, 4mg (£1.47 = 2 x 3mg daily)

Indications

Notes:

  1. Due to their cost risperidone 6mg tablets have not been included in the formulary. Prescribing 2 x 3mg tablets costs significantly less.
  2. No new patients will receive risperidone long-acting injection. There is an existing cohort of patients who will continue to receive risperidone.
Clozapine
  • Clozaril® Tablets 25mg, 100mg
  • Denzapine® Suspension 50mg/ml

Indications

  • Schizophrenia in patients unresponsive to, or intolerant of, conventional antipsychotic drugs

Notes:

  1. Prescribers, pharmacies and patients must be registered with either the Clozaril® Patient Monitoring Service (CPMS) for those taking tablets or the Denzapine® Monitoring Service (DMS) for those taking suspension. Make sure patients are registered in the correct service; they cannot be registered for both. Refer to hospital Pharmacy Department and the:
    1. DPT policy Pharmacological Treatment of Schizophrenia and Related Psychoses
    2. DPT Clinical Protocol for Clozapine CP19
  2. Treatment needs to re-titrated if there has been more than 48 hours between doses. Patient needs to be urgently reviewed by their specialist.
  3. MHRA Drug Safety Update (October 2017): Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
    1. the antipsychotic drug clozapine has been associated with varying degrees of impairment of intestinal peristalsis; this effect can range from constipation, which is very common, to very rare intestinal obstruction, faecal impaction, and paralytic ileus
    2. exercise particular care in patients receiving other drugs known to cause constipation (especially those with anticholinergic properties), patients with a history of colonic disease or lower abdominal surgery, and in patients aged 60 years and older
    3. advise patients to report constipation immediately and actively treat any constipation that occurs, with an osmotic and/or stimulant laxative.
Lurasidone

The routine commissioning of lurasidone is not accepted in Devon for patients with schizophrenia (see Commissioning Policy for more details).

 

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