GuidelinesOther guideline
Nervous System
Vigabatrin Topiramate Levetiracetam Gabapentin, Pregabalin Ropinarole, Pramipexole, Bromocriptine Olanzapine, IM Quetiapine Risperidone long acting injection Amisulpride Aripiprazole Alprazolam Zopiclone, Zolpidem Dexmedetomidine Mirtazapine Bupropion Venlafaxine Memantine ATC Code N03AG04 Medicine Vigabatrin Indication Refractory partial epilepsy NEMLC Recommendation Not Approved Review I
Ropinarole, Pramipexole, Bromocriptine
Risperidone long acting injection
| ATC Code | N03AG04 |
| Medicine | Vigabatrin |
| Indication | Refractory partial epilepsy |
| NEMLC Recommendation | Not Approved |
| Review Indicators | Good quality evidence to support the efficacy and safety in infantile spasms |
| Date Ratified | 3 December 2009 |
| ATC Code | N03AG04 |
| Medicine | Vigabatrin |
| Indication | Infantile spasms |
| NEMLC Recommendation | Not Approved |
| Review Indicators | Good quality evidence to support the efficacy and safety in infantile spasms |
| Date Ratified | 3 December 2009 |
| ATC Code | N03AX11 |
| Medicine | Topiramate |
| Indication | Initial therapy (epilepsy) |
| NEMLC Recommendation | Not Approved |
| Review Indicators | - New evidence, re: clinical efficacy of Topiramate vs. alternatives as add-on therapy for resistant epilepsy - New evidence, re: efficacy in comparison with alternatives as initial therapy for epilepsy, where the current evidence supports using the alternative agents |
| Date Ratified | 3 December 2009 |
| ATC Code | N03AX11 |
| Medicine | Topiramate |
| Indication | Add-on therapy for resistant epilepsy |
| NEMLC Recommendation | Approved |
| Review Indicators | Evidence that the product is accounting for disproportionate amount of anti-epileptic spend |
| Date Ratified | 26 March 2015 |
| ATC Code | N03AX14 |
| Medicine | Levetiracetam |
| Indication | Add-on therapy for resistant epilepsy |
| NEMLC Recommendation | Not Approved |
| Review Indicators | - Price - Data in HIV patients |
| Date Ratified | 25 June 2015 |
| ATC Code | N03AX12/ N03AX16 |
| Medicine | α2δ calcium channel ligands: Gabapentin, Pregabalin |
| Indication | Patients with peripheral neuropathy refractory or intolerant to standard of care (e.g. amitriptyline; or carbamazepine) |
| NEMLC Recommendation | Approved – Special Access Special access may be granted on recommendation by PTC in the refractory or intolerant setting |
| Review Indicators | - New evidence in the refractory setting - Alternative indications |
| Date Ratified | 30 January 2020 |
| ATC Code | N04BC04/ N04BC05/ G02CB01 |
| Medicine | Dopamine agonist: Ropinarole, Pramipexole, Bromocriptine |
| Indication | Parkinson’s disease |
| NEMLC Recommendation | Approved for use as add-on therapy to levodopa The choice of dopamine agonists and selegiline will depend on the lowest tender price |
| Review Indicators | - Decrease in relative cost - New safety data |
| Date Ratified | 27 November 2008 |
| ATC Code | N05AH03 |
| Medicine | Olanzapine, IM |
| Indication | Emergency management of psychotic conditions |
| NEMLC Recommendation | Not Approved |
| Review Indicators | New evidence of superior efficacy to suitable alternatives in patients with severe adverse reactions to FGAs |
| Date Ratified | 03 December 2009 |
| ATC Code | N05AH04 |
| Medicine | Quetiapine |
| Indication | Third-line schizophrenia |
| NEMLC Recommendation | Not Approved Amisulpride approved for this indication |
| Review Indicators | n/a |
| Date Ratified | 16 May 2024 Review evaluation. (First reviewed: 15 September 2016) |
| ATC Code | N05AX08 |
| Medicine | Risperidone long acting injection |
| Indication | Schizophrenia |
| NEMLC Recommendation | Not Approved |
| Review Indicators | Price similar to current standard of care |
| Date Ratified | 31 March 2016 |
| ATC Code | N05AL05 |
| Medicine | Amisulpride |
| Indication | Fourth-line schizophrenia |
| NEMLC Recommendation | Approved for use as an appropriate alternative to existing agents in patients with negative symptoms failing first and second generation antipsychotics |
| Review Indicators | Price |
| Date Ratified | 16 May 2024 Place in therapy updated (First reviewed: 03 December 2009 – for psychosis: with negative symptoms failing first- and second-generation antipsychotics) |
| ATC Code | N05AX12 |
| Medicine | Aripiprazole |
| Indication | Third-line schizophrenia |
| NEMLC Recommendation | Approved for use as an appropriate alternative to existing agents in patients with schizophrenia failing first- and second-line schizophrenia therapy options, and where clozapine not an option due to metabolic effects (weight gain, type II diabetes mellitus), as a step before amisulpride. |
| Review Indicators | Price |
| Date Ratified | 16 May 2024 |
| ATC Code | N05AX12 |
| Medicine | Aripiprazole |
| Indication | Schizophrenia in children |
| NEMLC Recommendation | Approved for use as a third-line agent in children with psychotic disorders who are intolerant to typical and atypical antipsychotic agents with: - Obesity, defined as BMI ≥30 or age appropriate measures, or - Excessive weight gain, if associated with metabolic syndrome in adherent patients on other atypical antipsychotics, not responsive to other interventions (e.g. dietary management and/or physical exercise) Aripiprazole be initiated, in these cases, in consultation with or, where available, by a subspecialist (i.e. child and adolescent psychiatrist) |
| Review Indicators | New evidence of efficacy in children and adolescents |
| Date Ratified | 29 November 2013 |
| ATC Code | N05BA12 |
| Medicine | Alprazolam |
| Indication | “As required” adjunctive medication in the treatment of panic disorder |
| NEMLC Recommendation | Approved for panic disorder only To be prescribed by a psychiatrist |
| Review Indicators | Any efficacy, safety or cost data |
| Date Ratified | September 2010 |
| ATC Code | N05CF01/ N05CF02 |
| Medicine | Benzodiazepine related drugs: Zopiclone, Zolpidem |
| Indication | Short-term use for insomnia associated with a primary psychiatric condition |
| NEMLC Recommendation | Not Approved |
| Review Indicators | If the price of z-drugs were reduced to within an acceptable distance of the price of oxazepam, consideration would be given to including these on the EML |
| Date Ratified | 03 December 2009 |
| ATC Code | N05CM18 |
| Medicine | Dexmedetomidine |
| Indication | Sedation of patients in intensive care requiring mechanical ventilation |
| NEMLC Recommendation | Not Approved |
| Review Indicators | - Price reduction - New evidence of safety or efficacy |
| Date Ratified | 20 July 2023 |
| ATC Code | N06AX11 |
| Medicine | Mirtazapine |
| Indication | Major Depressive Disorder (MDD) for the specific population groups: - Cardiac patients with MDD - Oncology patients with MDD who do not tolerate SSRIs/SNRIs - MDD patients who cannot tolerate or have failed on SSRIs/SNRIs/TCAs Treatment resistant MDD |
| NEMLC Recommendation | Not Approved |
| Review Indicators | Robust evidence of efficacy in specific groups |
| Date Ratified | 8 December 2022 |
| ATC Code | N06AX12 |
| Medicine | Bupropion |
| Indication | Major depressive disorder |
| NEMLC Recommendation | Approved for use as a third-line treatment of major depressive disorder and anxiety associated with depression To be prescribed by a psychiatrist only The cheapest of bupropion or venlafaxine to be used |
| Review Indicators | n/a |
| Date Ratified | 27 January 2011 |
| ATC Code | N06AX16 |
| Medicine | Venlafaxine |
| Indication | Major depressive disorder |
| NEMLC Recommendation | Approved for use as a third-line treatment of major depressive disorder and anxiety associated with depression To be prescribed by a psychiatrist only The cheapest of bupropion or venlafaxine to be used |
| Review Indicators | New evidence of harm, or a revision in the price of bupropion to make it more economically favourable |
| Date Ratified | 27 January 2011 |
| ATC Code | N06DX01 |
| Medicine | Memantine |
| Indication | Alzheimer’s Disease |
| NEMLC Recommendation | Not Approved |
| Review Indicators | Evidence of true clinical benefit in terms of quality of life for patients and care-givers |
| Date Ratified | 10 July 2008 |