CNS depression potentiated with alcohol, other CNS depressants. Possible neurotoxicity with lithium: monitor, discontinue if occurs. Caution with drugs that prolong the QT interval (eg, ketoconazole, paroxetine). May be potentiated by CYP3A4 inhibitors/substrates or CYP2D6 enzymes (eg, itraconazole, nefazodone, buspirone, venlafaxine, alprazolam, fluvoxamine, quinidine, fluoxetine, sertraline, chlorpromazine, promethazine. May be antagonized by CYP3A4 inducers (eg, rifampin, carbamazepine); monitor and adjust doses. May increase intraocular pressure with anticholinergics. Monitor anticoagulants.

It is anticipated that this Formulary will evolve through debate and suggestion and as new drugs become available.  Requests for amendments to the formulary can only be made by psychiatrists and should be made by submitting the Application to Amend the Formulary Form which can be accessed from either the netFormulary or at the following web page: http:///services/pharmacy/information-for-professionals/formulary .  Genuine ownership of the Formulary by clinicians in the Trust who prescribe for people with mental health problems will help to refine it and enhance its relevance to everyday clinical practice.

The intravenous route is not FDA approved and is generally not recommended except when no other alternatives are available. Intravenous administration appears to be associated with a higher risk of QT prolongation and torsade de pointes (TdP) than other forms of administration. The manufacturer recommends ECG monitoring for QT prolongation and arrhythmias if IV administration is required. A dose in the range of 1 to 5 mg IV has been suggested, with the dose being repeated at 30 to 60 minute intervals, if needed. A maximum IV dose has not been established. The lowest effective dose should be used in conjunction with conversion to oral therapy as soon as possible.