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3.1 Anxiety

Anxiolytics

See GAD Stepped care model
See NICE CG113 Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults
See NICE CG 159 Social anxiety disorder

 Anxiolytics Preparations Comments
Buspirone† 5mg and 10mg tablets May take up to 2 weeks to see response. More costly than benzodiazepines.
Chlordiazepoxide hydrochloride 5mg and 10mg tablets Used as an adjunct in acute alcohol withdrawal. See section 4.10.1
Diazepam 2mg and 5mg tablets
2mg/5ml oral solution
 
Lorazepam 1mg tablets
4mg/ml injection
Injection for HPFT prescribing only
Oxazepam 10mg and 15mg tablets Preferred choice in hepatic impairment.
Pregabalin 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg and 300mg capsules Approved for 4th line treatment option of generalised anxiety disorder. Named patient request. To be initiated in secondary care, and then continued in primary care.
NOT approved for neuropathic pain in Hertfordshire.
See section 4.8 for use in epilepsy.
Flat pricing structure - prescribe lowest number of capsules to achieve required dose. eg 100mg tds is 33% more costly than 150mg bd
Duloxetine  30mg and 60mg capsules Approved for 4th line treatment option of generalised anxiety disorder. To be initiated in secondary care and then continued in primary care. See also section 4.3.4 for restricted use in depression.
Note: 20mg and 40mg strengths (marketed as Yentreve®) are not licensed for depression.
Propranolol 10mg and 40mg tablets Beta-blocker - for managing physical signs of anxiety.
See BNF chapter 2 section 4.1 for drug monograph.

 † - denotes a less preferred choice of medicine.

 

Continue to 3.2 Attention deficit hyperactivity disorder

 

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