Dementia Specialist formulary list

**Other indications for particular drugs may be included on completion of further specialist lists**

For information on use of unlicensed medicines or medicines used 'off-label' - click here

The following medicines are approved for prescribing by or on the recommendation of a Psychiatrist or Medicine for the Elderly specialist:

MEDICINE	SUMMARY OF RESTRICTED INDICATION	CATEGORY	PROTOCOL
Clomethiazole capsules	Insomnia in the elderly or people with dementia (short-term use).
Clomethiazole edislate syrup (unlicensed) (available from Movianto as named patient)
Quetiapine tablets	Behavioural and psychological symptoms of dementia (BPSD) (Psychosis, aggression, severe agitation/anxiety) in dementia with Lewy bodies (DLB) or in patients with Parkinson’s disease. (unlicensed use ‘off-label’) SEE GOOD PRACTICE GUIDES Second line for BPSD in AD. (unlicensed use ‘off-label’) SEE GOOD PRACTICE GUIDES		Rationalisation of Antipsychotics in people with Dementia – Good Practice Guide for initiation of treatment Good Practice Guide for reduction and cessation of treatment
Trazodone tablets, capsules, liquid	Depressive symptoms and dementia associated agitation.		SIGN 86 Management of patients with dementia
Donepezil hydrochloride tablets, orodispersible tablets	Mild to moderate Alzheimer’s Disease (AD).	(Note:  in Perth & Kinross)	Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s Disease - Shared Care Agreement (Angus & Dundee). (Staffnet intranet link only). SIGN 86 Management of patients with dementia       Initial 6 to 9 months memantine prescribed from Psychiatry of Old Age (Angus & Dundee).
Galantamine tablets, m/r capsules, oral solution	Mild to moderate AD.
Rivastigmine capsules, oral solution	Mild to moderate AD.
Rivastigmine patches	Moderately severe AD in patients who require once daily administration or have swallowing difficulties.
Memantine hydrochloride tablets, oral solution	Moderate AD in those who are intolerant of or have a contraindication to cholinesterase inhibitors, or those with severe AD.
Galantamine tablets, m/r capsules, oral solution	Cognitive decline in people with mixed dementias (unlicensed use ‘off-label’).	(Note:  in Perth & Kinross)	SIGN 86 Management of patients with dementia
Rivastigmine capsules, patches, oral solution	Cognitive decline or the management of associated symptoms (behavioural and psychological symptoms (BPSD)) in people with dementia with Lewy bodies (unlicensed use ‘off-label’)

 

Traffic light status information
	To be prescribed by Hospital Specialists Only.
	Can be prescribed in General Practice under the direction of a Specialist.

The following medicines that may be prescribed by specialists in patients with dementia may also be initiated by GPs or non-specialists where appropriate (advice would normally be sought from specialists). These medicines are included here for information and are also within the formulary.

A Dementia Integrated Care Pathway (ICP) for use in NHS Tayside has been developed. This is not yet available electronically.

Other NHS Tayside guidance that healthcare professionals should be aware of for the care of older adults includes The Management of Delirium in adult and older in-patients and Medication review in frail older people on multiple medicines.

Dementia, delirium and depression are the three most prevalent psychiatric disorders in older people. All three conditions can have similar symptoms and older people may often be suffering from more than one of these conditions making diagnosis difficult. Delirium is very common and often treatable in older people, especially in those in hospital or residential care and despite the fact that delirium is a common and serious condition it is frequently unrecognised. See the NHS Tayside guidance on the management of delirium in adult and older in-patients for information on distinguishing features of delirium, depression and dementia.