Shared-care Guidelines

Methylphenidate, Lisdexamfetamine, Dexamfetamine, Atomoxetine - For Attention Deficit Hyperactivity Disorder in adults aged over 17 years and in children and adolescents aged 6 to 17 years

Guanfacine - For Attention Deficit Hyperactivity Disorder in children and adolescents aged 6 to 17 years 

Amisulpride, Aripiprazole, Olanzapine, Quetiapine, Oral Risperidone
This shared prescribing guideline for the second-generation antipsychotic medications listed above has been developed with due consideration to the appropriate NICE Clinical Guidelines (CG) e.g. Bipolar Disorder (CG185), Psychosis and Schizophrenia in Children and Young People (CG155), Psychosis and Schizophrenia in Adults (CG178), Schizophrenia- Aripiprazole (TA213), Bipolar Disorder- Adolescents (TA292).

Please note: Morecambe Bay CCG has now adopted this Shared-care guideline for all areas, including South Cumbria. 

Refer to Local Commissioning Policy Before Use

Treatment of Parkinson’s Disease

This guidance does not replace the SPC’s, which should be read in conjunction with this guidance. 

This guidance does not replace the SPC’s, which should be read in conjunction with this guidance.

Denosumab 120mg injection - Prevention of skeletal-related events (pathological fracture, radiation to bone, spinal cord compression or surgery to bone) in adults with advanced malignancies involving bone.

Treatment of adults and skeletally mature adolescents with giant cell tumour of bone that is unresectable or where surgical resection is likely to result in severe morbidity.

Denosumab 60mg injection - Treatment of osteoporosis in postmenopausal women and in men at increased risk of fracture and treatment of bone loss
associated with long-term systemic glucocorticoid therapy in adult patients at increased risk of fracture

Treatment of active rheumatoid arthritis and active psoriatic arthritis.

Licensed Indications

1. In the management of acute mania or hypomanic episodes
2. In the management of episodes of recurrent depressive disorders where treatment with other antidepressants has been unsuccessful
3. In the prophylaxis against bipolar affective disorders
4. Control of aggressive behaviours of intentional self-harm.

Rheumatoid arthritis, severe psoriasis, severe active juvenile idiopathic
arthritis, severe psoriatic arthritis, mild to moderate Crohn’s disease
Unlicensed: Severe Eczema, Lichen Planus, Felty’s syndrome, severe Crohn’s disease

N.B. Not all brands/formulations are licensed for all indications – please refer to individual SPCs

This protocol only applies to the unlicensed indications listed below. Transplant protocols should be followed for licensed indications.

Unlicensed: Severe rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, connective tissue diseases with severe / organ-threatening manifestations, interstitial lung disease (not to be used in idiopathic pulmonary fibrosis IPF), vasculitidies, as maintenance post cyclophosphamide in patients for whom azathioprine is contra-indicated or is inappropriate.

Licensed: Severe active rheumatoid arthritis, including juvenile forms, Wilson's disease (hepatolenticular degeneration) in adults and children (0 to 18 years).

To extend life or the time to mechanical ventilation for adult patients with amyotrophic lateral sclerosis (ALS) 1,2, variant of Motor Neurone Disease (MND). Safety and efficacy of riluzole has only been studied in ALS. Therefore, riluzole should not be used in patients with any other forms of MND. Riluzole should only be initiated by a neurological specialist with expertise in the management of MND (as per NICE TA 20, 2001)

It is expected that most patients will be managed by secondary care however this guideline is those patients who need to be managed in community

Licensed: Rheumatoid arthritis; ulcerative colitis, Crohn’s disease in adults and children
Unlicensed: Sero-negative spondyloarthropathy including psoriatic arthritis and psoriasis.

For hypogonadism due to testosterone deficiency in adult men

Indication (licensed):Testosterone replacement therapy for male hypogonadism when testosterone deficiency has been confirmed by clinical features and biochemical tests.

Unlicensed indication: As supplementation for postmenopausal women with low sexual desire if HRT alone is not effective.