Do not use for acute pain. Do not use in opiate naive patients. Prescribe by brand (see drug list below)
96 hour patch - Licensed for moderate to severe cancer pain and severe pain which does not respond to non-opioid analgesics. The patches are equivalent to strong opioid doses and are not suitable for the treatment of acute pain. They should be reserved for patients who are nil by mouth or where there is severe renal impairment.
7 day patch - The patches may be useful only for people that have not responded to maximum dose oral weak opioid analgesia and that require continuous release pain control. Also consider in patients who are nil by mouth or with mild to moderate renal impairment.
| Pack |
|---|
| 2 patch |
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 5 patch |
| 4 patch |
| 3 patch |
| 6 patch |
| Pack |
|---|
| 5 patch |
| 4 patch |
| 3 patch |
| 6 patch |
| Pack |
|---|
| 5 patch |
| 4 patch |
| 3 patch |
| 6 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 4 patch |
| Pack |
|---|
| 50 tablet |
| Pack |
|---|
| 7 tablet |
| Pack |
|---|
| 7 tablet |
| Pack |
|---|
| 7 tablet |
First choice - mild to moderate pain
Syrup reserved for those with swallowing difficulties or specific clinical need
Codeine is contraindicated in all children under 12 and for children up to 18 years for pain relief after tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome.
| Pack |
|---|
| 30 tablet |
| 100 tablet |
| 28 tablet |
| 500 tablet |
| Pack |
|---|
| 28 tablet |
| 100 tablet |
| 500 tablet |
| 30 tablet |
| Pack |
|---|
| 28 tablet |
| 100 tablet |
| 30 tablet |
| Pack |
|---|
| 100 ml |
| 200 ml |
| 2000 ml |
| 500 ml |
| Pack |
|---|
| 2000 ml |
| 200 ml |
| 500 ml |
| Pack |
|---|
| 500 ml |
Co-codamol 8mg/500mg effervescent tablets available OTC in various pack sizes under 100 tablets
Dispersible tablets have high sodium content up 16.9mmol Na+ per tablet
| Pack |
|---|
| 30 tablet |
| 100 tablet |
| 50 tablet |
| 32 tablet |
| 500 tablet |
| 1000 tablet |
| 12 tablet |
| 48 tablet |
| 24 tablet |
| 4 tablet |
| 8 tablet |
| 16 tablet |
| Pack |
|---|
| 30 tablet |
| 500 tablet |
| 100 tablet |
| Pack |
|---|
| 20 capsule |
| 10 capsule |
| 24 capsule |
| 32 capsule |
| 100 capsule |
| Pack |
|---|
| 100 capsule |
| 24 capsule |
| 8 capsule |
| 30 capsule |
| Pack |
|---|
| 60 tablet |
| 100 tablet |
| 12 tablet |
| 24 tablet |
| 32 tablet |
| Pack |
|---|
| 100 tablet |
| 90 tablet |
| 30 tablet |
| 32 tablet |
Other strengths are non-formulary
Second Choice: Combination preparations are not routinely recommended
| Pack |
|---|
| 12 tablet |
| 24 tablet |
| 32 tablet |
| Pack |
|---|
| 500 tablet |
| 100 tablet |
| 30 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 100 ampoule |
| 5 ampoule |
| Pack |
|---|
| 100 ampoule |
| 5 ampoule |
| Pack |
|---|
| 5 ampoule |
Oral solution reserved for paediatric use and those with swallowing difficulties or specific clinical need
Second line after codeine - moderate to severe pain
| Pack |
|---|
| 100 tablet |
| 500 tablet |
| 30 tablet |
| 28 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 150 ml |
| Pack |
|---|
| 1 ml |
| Pack |
|---|
| 1 ml |
| Pack |
|---|
| 1 ml |
| Pack |
|---|
| 1 ml |
| Pack |
|---|
| 5 patch |
| Pack |
|---|
| 5 patch |
| Pack |
|---|
| 5 patch |
| Pack |
|---|
| 5 patch |
| Pack |
|---|
| 5 patch |
| Pack |
|---|
| 5 patch |
| Pack |
|---|
| 10 tablet |
| 30 tablet |
| Pack |
|---|
| 10 tablet |
| 30 tablet |
| Pack |
|---|
| 10 tablet |
| 30 tablet |
| Pack |
|---|
| 10 tablet |
| 30 tablet |
| Pack |
|---|
| 30 tablet |
| Pack |
|---|
| 30 tablet |
| Pack |
|---|
| 4 tablet |
| 28 tablet |
| Pack |
|---|
| 4 tablet |
| 28 tablet |
| Pack |
|---|
| 4 tablet |
| 28 tablet |
| Pack |
|---|
| 4 tablet |
| 28 tablet |
| Pack |
|---|
| 4 tablet |
| 28 tablet |
| Pack |
|---|
| 10 dose |
| 20 dose |
| 8 dose |
| 32 dose |
| 6 dose |
| Pack |
|---|
| 8 dose |
| 32 dose |
GREEN - Palliative care
Prescribe modified-release preparations by brand. Zomorph capsules are the preferred brand.
For adults with swallowing difficulties: open Zomorph capsules, mix contents with semisolid food (puree, jam, yoghurt). Gastric / gastroscopy tubes (diameter > 16 F.G. with an open distal end or lateral pores): open Zomorph capsules, pour contents down tube. Rinse tube with 30ml - 50ml water.
MST suspension sachets are only to be used in paediatrics or patients with a feeding tube.
Controlled Drug except for oral solution 10mg in 5ml.
Â
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 capsule |
| Pack |
|---|
| 60 capsule |
| 28 capsule |
| Pack |
|---|
| 60 capsule |
| 28 capsule |
| Pack |
|---|
| 28 capsule |
| Pack |
|---|
| 60 capsule |
| Pack |
|---|
| 28 capsule |
| Pack |
|---|
| 28 capsule |
| Pack |
|---|
| 60 capsule |
| 28 capsule |
| Pack |
|---|
| 100 ml |
| 300 ml |
| 500 ml |
| Pack |
|---|
| 30 ml |
| 120 ml |
| Pack |
|---|
| 1 ampoule |
| 10 ampoule |
| 5 ampoule |
| Pack |
|---|
| 1 ampoule |
| 10 ampoule |
| 5 ampoule |
| Pack |
|---|
| 5 ampoule |
| 10 ampoule |
| Pack |
|---|
| 5 ampoule |
| 10 ampoule |
| Pack |
|---|
| 10 ampoule |
| Pack |
|---|
| 5 ampoule |
| 10 ampoule |
| Pack |
|---|
| 5 ampoule |
| Pack |
|---|
| 1 vial |
| 10 vial |
GREEN - Brighton & Hove and Crawley, Horsham and Mid Sussex
NON-FORMULARY - Coastal West Sussex and East Sussex
| Pack |
|---|
| 90 tablet |
| 30 tablet |
| Pack |
|---|
| 56 capsule |
| Pack |
|---|
| 56 capsule |
| Pack |
|---|
| 56 capsule |
| Pack |
|---|
| 28 tablet |
| Pack |
|---|
| 56 tablet |
| 28 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| 28 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| 28 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| 28 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 250 ml |
| Pack |
|---|
| 120 ml |
GREEN - Palliative careÂ
Appendix 4 Palliative Care Pain and/or Breathlessness
For analgesia:
GREEN - Coastal West Sussex
PURPLE - Crawley, Horsham and Mid Sussex
RED - East Sussex
NON-FORMULARY - Brighton & Hove
| Pack |
|---|
| 5 ampoule |
| 10 ampoule |
| Pack |
|---|
| 5 ampoule |
| 10 ampoule |
| Pack |
|---|
| 5 ampoule |
| 10 ampoule |
| Pack |
|---|
| 1000 tablet |
| 12 tablet |
| 48 tablet |
| 32 tablet |
| 30 tablet |
| 50 tablet |
| 5000 tablet |
| 24 tablet |
| 100 tablet |
| 8 tablet |
| 96 tablet |
| 16 tablet |
| 14 tablet |
| 20 tablet |
| Pack |
|---|
| 100 tablet |
| Pack |
|---|
| 16 tablet |
| 24 tablet |
| 60 tablet |
| 12 tablet |
| 100 tablet |
| Pack |
|---|
| 60 tablet |
| 100 tablet |
| 24 tablet |
| Pack |
|---|
| 50 tablet |
| Pack |
|---|
| 24 tablet |
| 12 tablet |
| Pack |
|---|
| 70 ml |
| 100 ml |
| 1000 ml |
| 500 ml |
| 150 ml |
| 200 ml |
| 140 ml |
| Pack |
|---|
| 100 ml |
| 500 ml |
| 200 ml |
| Pack |
|---|
| 1000 ml |
| 100 ml |
| 500 ml |
| 200 ml |
| 80 ml |
| Pack |
|---|
| 10 suppository |
| Pack |
|---|
| 10 suppository |
| Pack |
|---|
| 10 suppository |
| Pack |
|---|
| 10 suppository |
| Pack |
|---|
| 10 suppository |
| Pack |
|---|
| 10 suppository |
| Pack |
|---|
| 10 suppository |
| Pack |
|---|
| 1 suppository |
| 12 suppository |
| 10 suppository |
| Pack |
|---|
| 50 tablet |
| Pack |
|---|
| 10 ampoule |
| Pack |
|---|
| 10 ampoule |
PURPLE - Crawley, Horsham and Mid Sussex:
Severe persistent non-malignant pain in adults.
Tapentadol SR was agreed as a treatment option after assessment by a pain specialist for patients not responding to / not tolerating morphine or oxycodone.
Tapentadol IR may be used for breakthrough pain whilst uptitrating tapentadol SR.
NON-FORMULARY - Coastal West Sussex, East Sussex and Brighton & Hove
| Pack |
|---|
| 28 tablet |
| 56 tablet |
| Pack |
|---|
| 28 tablet |
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 28 tablet |
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
| Pack |
|---|
| 56 tablet |
Use with caution with patients with a history of epilepsy. Psychiatric reactions have been reported.
Tramadol is neither more effective nor better tolerated than other weak opioid analgesics for moderate to severe pain and its safety profile is problematic. Where use of tramadol is considered necessary for control of chronic pain, the use of SR preparations of tramadol should be considered.
Marol MR is the most cost effective preparation in primary care.
| Pack |
|---|
| 100 capsule |
| 30 capsule |
| 140 capsule |
| 105 capsule |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| Pack |
|---|
| 60 tablet |
| 30 tablet |
| Pack |
|---|
| 60 tablet |
| 30 tablet |
| 28 tablet |
| Pack |
|---|
| 60 tablet |
| 30 tablet |
| 28 tablet |
| Pack |
|---|
| 30 tablet |
| 28 tablet |
| Pack |
|---|
| 30 tablet |
| 28 tablet |
| Pack |
|---|
| 60 capsule |
| Pack |
|---|
| 60 capsule |
| Pack |
|---|
| 60 capsule |
| Pack |
|---|
| 60 capsule |