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. Refer to individual shared care guidelines for use in Central Nervous System conditions
  2. NICE TA20: Riluzole is recommended for the treatment of individuals with the amyotrophic lateral sclerosis (ALS) form of Motor Neurone Disease (MND) (January 2001)
Tetrabenazine
  • Tablets 25 mg (£100.00 = 112 tablets)
Botulinum Toxin Type A
  • Botox® powder for solution for injection 50 unit, 100 unit, 200 unit vials
  • Dysport® powder for solution for injection 300 unit, 500 unit vials
  • Xeomin® powder for solution for injection 50 unit, 100 unit, 200 unit vials

Indications

  • Blepharospasm
  • Chronic anal fissure
  • Focal hyperhidrosis
  • Hemifacial spasm
  • Urinary incontinence due to detrusor overactivity
  • Prophylaxis of headaches in adults with chronic migraine
  • Chronic sialorrhoea caused by neurological conditions in adults

Notes

  1. Prescribe by brand. Botulinum toxin type A units are not interchangeable from one product to another, please consult Summary of Product Characteristics (SPCs) and BNF for details of cautions, specific side effects, contraindications, and differences in licensed indications
  2. Botulinum toxin type A should only be administered by appropriately trained specialists
  3. The routine commissioning of botulinum toxin type A injection is accepted in Devon for the management of blepharospasm only when specified criteria are met (see Commissioning Policy for more details)
  4. The routine commissioning of botulinum toxin type A injection is accepted in Devon 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)
  5. The routine commissioning of botulinum toxin type A injection is accepted in Devon for the management of focal hyperhidrosis only when specified criteria are met (see Commissioning Policy for more details)
  6. The routine commissioning of botulinum toxin A is accepted in Devon for the management of hemifacial spasm when the condition causes the patient to be affected to at least a moderate degree by one or more of the criteria specified in the policy (see Commissioning Policy for more details)
  7. The routine commissioning of bladder wall botulinum toxin injection for use in adult male and female patients with urinary incontinence due to detrusor overactivity is accepted in Devon, when used in accordance with the relevant NICE clinical guideline (see Commissioning Policy for more details)
  8. NICE TA260: Botulinum toxin type A (Botox) is recommended as an option for the prophylaxis of headaches in adults with chronic migraine (defined as headaches on at least 15 days per month of which at least 8 days are with migraine) (June 2012):
    1. that has not responded to at least three prior pharmacological prophylaxis therapies and
    2. whose condition is appropriately managed for medication overuse
  9. NICE TA605: Botulinum neurotoxin type A (Xeomin) is recommended as an option for treating chronic sialorrhoea caused by neurological conditions in adults (October 2019)
  10. Botulinum toxin type A is included in both NICE CG145: Spasticity in under 19s (July 2012) and NICE CG148: Urinary incontinence in neurological disease (August 2012)
Mexiletine
  • Namuscla® capsules 167mg
  • Capsules 50mg, 100mg (unlicensed special)

Indication

  • Non-dystrophic myotonic disorders (NHS England commissioned)
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.

 

Home > Formulary > Chapters > 4. Central Nervous System > 4.9 Drugs used in parkinsonism and related disorders > 4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders

 

  • First line
  • Second line
  • Specialist
  • Hospital