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REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Adult Joint Formulary
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Decisions 31st January 2023

New Drug Requests


Verapamil (IV) (TLS Red)

  • For cerebral arterial vasospasm post-acute aneurysmal subarachnoid haemorrhage, causing focal neurological deficit or reduction in GCS. For use by interventional neuroradiology only.

  • TLS of Nimodipine for subarachnoid haemorrhage changed from amber no SCP to TLS Red.


Shared Care Protocols


  • New shared care protocol approved for Verapamil immediate release tablets for cluster headache for patients <75 years and without a history of hypertension.

    - Verapamil for cluster headache for patients  <75 years and without a history of hypertension changed to amber 3 months. See shared care protocol

    Verapamil for cluster headache remains TLS red for patients aged 75 and over and for those with a history of hypertension. 


  • Glycopyrronium for hypersalivation (sialorrhoea)/ saliva management in people with swallowing problems (bulbar dysfunction) and with neurological conditions, motor neurone disease (MND) or Parkinson’s Disease (PD) in line with the hypersalivation pathway. The Shared Care Protocol has been updated to incorporate Parkinson's Disease. See information on 12.3 page


Traffic Light Status Change Requests

  • Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia as an adjunct to diet in adults in line with NICE TA694 to be changed from TLS red to TLS amber 3 months pending the approval of a shared care protocol. Bempedoic acid remains TLS red until the shared care protocol is approved and published on Remedy. 


Other Formulary Decisions

  • Actimorph (morphine sulfate immediate release orodispersible tablets) added to the Adult BNSSG Formulary as TLS blue as an alternative for patients not able to tolerate oral morphine sulfate solution, or if this is not suitable due to safety concerns.

  • Sevredol (morphine sulfate immediate release tablets) TLS change from green to blue

  • The Joint Formulary Group Terms of Reference are under review and being updated. 

  • The New Drug Request application form due to be updated.