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1. Dementia

Dementia

Dementia Preparations Comments

Drugs for dementia to be initiated by HPFT for commissioned services only.  Transfer of care can take place for patients whose care is commissioned by HVCCG and ENHCCG in line with the transfer of care guidelines.  HPFT specialist to request transfer of care by using the agreed template letter.

NICE TA217 - Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease.
Hertfordshire Care Pathway: Management of Behavioural and Psychological Symptoms of Dementia (BPSD).

Note: Orodispersible tablets and oral solution formulations are significantly more costly than standard tablet formulations and use of such formulations should be regularly reviewed and switched to standard tablets where possible and clinically appropriate.

Donepezil hydrochloride 5mg and 10mg tablets
5mg and 10mg orodispersible tablets
Orodispersible tablets only to be prescribed in those who cannot swallow solid dose forms
Galantamine 8mg and 12mg tablets
8mg,16mg and 24mg MR (XL) capsules
4mg/ml oral solution
MR/XL capsules more cost-effective than standard release tablets.
Oral solution only to be prescribed in those who cannot swallow solid dose forms.
Memantine hydrochloride

Film coated tablets:                                                            5mg, 10mg and 20mg tablets (including titration pack)

Orodispersible tablets:                                                           10mg and 20mg

Titration pack containing 7 tablets of each strength 5mg, 10mg, 15mg, 20mg

Recommended as an option for managing Alzheimer's disease for people with:

  • moderate Alzheimer's disease who are intolerant of or have a contraindication to acetylcholinesterase inhibitors or
  • severe Alzheimer's disease.

Named patient request for all other dementias and BPSD.

Orodispersible tablets only to be prescribed in those who cannot swallow with solid dose forms.

Rivastigmine 1.5mg, 3mg, 4.5mg, 6mg capsules
Patches 4.6mg/24 hours
2mg/ml oral solution
Oral solution is significantly more expensive than capsules or transdermal patches and should only be used when these formulations are not appropriate.

 

Continue to 2. Epilepsy and other seizures

 

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