S8 stimulant medicines
Schedule 8 (S8) stimulant medicines include dexamfetamine, lisdexamfetamine and methylphenidate.
Part 3 of the Monitored Medicines Prescribing Code (the Code) outlines the prescribing conditions and requirements for S8 stimulant medicines, including:
- when prescribers may prescribe them without authorisation of the CEO (including when part of shared-care arrangements);
- when prescribers require written authorisation from the CEO before prescribing them.
It also details how to apply for authorisation from the CEO.
Authorisation of the CEO
When is prior authorisation of the CEO required?
Figure 5 from the Code summarises when authorisation from the CEO is and is not required for S8 stimulant medicines.
For the purposes of Part 3 of the Code, an Approved Specialist is a medical practitioner who holds specialist registration on the AHPRA register of practitioners in a Speciality, or Speciality Field, relevant to the diagnosed condition the S8 stimulant medicine is being prescribed for (as set out in Table 3 of the Code).
Table 3: Approved specialists (AHPRA speciality or speciality field) and approved diagnoses
|
AHPRA speciality or speciality fields
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Approved diagnoses
|
|
Neurology
Paediatric neurology
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Acquired Brain Injury
Attention Deficit Hyperactivity Disorder (ADHD)
Narcolepsy
|
|
Paediatric and child health |
ADHD
|
|
Psychiatry
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Acquired Brain Injury
ADHD
Moderate-Severe Binge Eating Disorder in an adult
Depression
|
Rehabilitation medicine
Paediatric rehabilitation medicine
|
Acquired Brain Injury |
|
Respiratory and sleep medicine
|
Narcolepsy
|
Applying for authorisation
Where prescribing is not in accordance with Section 3.5 of the Code, written authorisation from the CEO is required prior to prescribing an S8 stimulant medication.
Where authorisation to prescribe S8 stimulant medication is required, an Approved Specialist must apply to the CEO for authorisation. The application must be on the application form, which must be completed in full and be accompanied by supporting documentation as outlined on the form.
Application form
Applications must include treatment rationale, evidence to support unapproved indications, urine drug screens and other materials as specified. All applications are assessed by the Stimulant Assessment Panel.
General conditions for prescribing S8 stimulant medicines
All prescribing must conform to the criteria and conditions outlined within Part 1 and Part 3 of the Code.
Only one S8 stimulant prescriber is permitted at one time for each patient. Prior to prescribing an S8 stimulant medicine, the prescriber must check ScriptCheckWA to ensure there is no current active prescription or outstanding repeat.
All prescribing should be in accordance with current published and approved Product Information, recommendations from the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Royal Australasian College of Physicians, and Royal Australian College of General Practitioners, best practice guidelines, and evidence-based medicine standards. Treatment should be in accordance with a management plan, which considers all available treatment options, including non-pharmacological.
RANZCP’s Professional Practice Guideline 7: Guidance for psychotropic medication use in children and adolescents (external site), recommends that “The psychiatrist best placed to prescribe psychotropic medication is a child and adolescent psychiatrist with specialist training and experience with children."
Treatment of any patient less than 2 years of age with an S8 stimulant medication is not permitted.
Calculating dexamfetamine dose equivalents
As part of determining if treatment meets the Product criteria (Section 3.5.3) outlined in the Code, practitioners must ensure the maximum total daily dose of stimulants does not exceed an equivalent dexamfetamine dose of:
- 1 mg/kg/day, up to a maximum of 60 mg/day, for patients under 18 years;
- a maximum of 60 mg/day for patients greater than or equal to 18 years.
To determine the total daily stimulant dose as dexamfetamine equivalents, please use the: 'Dex-Equiv Dose- Converter' (Excel 387KB) This information is a guide to calculating dexamfetamine equivalents only. It is not intended to be used alone to switch patients from one stimulant agent to another.
Further information around dose limits, including dose limits of methylphenidate and lisdexamfetamine as single agents, is available in Section 3.5.3 of the Code.
More information
Medicines and Poisons Regulation Branch
Mailing address: PO Box 8172, Perth Business Centre, WA 6849
Phone: 9222 4424 (Monitored Medicines Prescriber Advisory Line)
Email: MPRB@health.wa.gov.au
Last reviewed: 06-12-2024
Produced by
Medicines and Poisons Regulation Branch
