4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders

Riluzole
  • Tablets 50mg (£14.37)

Indications

  • To extend life in patients with amyotrophic lateral sclerosis, initiated by specialists experienced in the management of motor neurone disease

Dose

  • 50mg twice daily

Notes

  1. NICE TA20 - Riluzole for motor neurone disease (January 2001)
Tetrabenazine
  • Tablets 25 mg (£100.00 = 112 tablets)
Botulinum toxin type A
  • Botox® Injection
  • Dysport® Injection

Notes

  1. NICE TA260 Botulinum toxin type A for the prevention of headaches in adults with chronic migraine (June 2012)
  2. Chronic migraine definition: patient experiences headaches on at least 15 days each month, with migraine on at least 8 of these days.
  3. Botox® is also approved as a red drug for use in hyperhidrosis. See 13.4 Perspiration for more information.
  4. Botox® must only be administered by an appropriately trained specialist.
  5. Dysport® is indicated for the treatment of spasmodic torticollis, blepharospasm and hemifacial spasm in adults.
  6. Botulinum toxin type A is included in both NICE CG145: Spasticity in children and young people (July 2012) and NICE CG148: Urinary incontinence in neurological disease (August 2012).
  7. For the treatment of chronic anal fissure in adults following failure of conservative management and topical treatments (to include GTN and diltiazem) and where surgery is considered the only other option (See Commissioning Policy for more details).
  8. Bladder wall botulinum toxin injection for use in adults with urinary incontinence due to detrusor overactivity is approved for use in Devon, when used in accordance with the relevant NICE clinical guideline (see Commissioning Policy for more details).
  9. The routine commissioning of botulinum toxin injection has been accepted in Devon for the treatment of blepharospasm only when specified criterea are met (see Commissioning Policy for more details)
  10. The routine commissioning of botulinum toxin injection has been accepted in Devon for the treatment of hemifacial spasm only when specified criterea are met (see Commissioning Policy for more details)
Piribedil
  • Tablets 20mg and 50mg SR

Indication

  • Piribedil should only be used in tremor associated with Parkinson's disease

Dose

  • Start at 20mg daily and increase slowly to 50mg three times a day

Notes

  1. Piribedil is unlicensed in the UK, but is available on a named patient only basis. It is used for tremor resistant to other forms of treatment and should only be initiated under specialist supervision.

 

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