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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
Notes:

This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net

For more information about the formulary development process, please see: https://www.lancsmmg.nhs.uk/lancashire-and-south-cumbria-icb-formulary-development/

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10.01  Expand sub section  Drugs used in rheumatic diseases and gout
BelimumabBlack Triangle (Benlysta® )
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

Concentrate for solution for infusion 120mg, 400mg

Black RAG for NICE TA806: TA806 Belimumab for treating lupus nephritis (terminated appraisal) 

 
Link  MHRA: Belimumab (Benlysta▼): increased risk of serious psychiatric events seen in clinical trials
Link  NICE TA752:Belimumab for treating active autoantibody-positive systemic lupus erythematosus
Link  NICE TA806: Belimumab for treating lupus nephritis (terminated appraisal)
 
10.01  Expand sub section  Rheumatoid arthritis and other inflammatory disorders
10.01  Expand sub section  Osteoarthritis and soft-tissue disorders
10.01.01  Expand sub section  Non-steroidal anti-inflammatory drugs
Ibuprofen
View adult BNF View SPC online View childrens BNF
First Choice
Green

Tablets 200mg, 400mg, 600mg
M/R tablets 800mg
Liquid 100mg/5mL

Red Solution for infusion 400mg/100mL

 
Naproxen
View adult BNF View SPC online View childrens BNF
First Choice
Green

Tablets 250mg, 500mg
Effervescent tablets 250mg

Evidence suggests that naproxen is aassociated with a lower cardiovascular risk than COX-2 inhibitors, diclofenac or high dose ibuprofen.
naproxen is the preferred option for patients requiring long-term treatment with a more potent NSAID than ibuprofen

 
Celecoxib (Celebrex®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Capsules 100mg & 200mg 
 
Etoricoxib (Arcoxia®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Tablets 60mg, 90mg, 120mg

Rheumatology initiation only

 
Link  MHRA: Etoricoxib (Arcoxia): revised dose recommendation for rheumatoid arthritis and ankylosing spondylitis
 
Indometacin
View adult BNF View SPC online View childrens BNF
Formulary
Green
Capsules 25mg
M/R capsules 75mg
Suppositories 100mg

Indometacin is usually only recommended for gout 
 
Meloxicam
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 7.5mg, 15mg 
 
Phenylbutazone
View adult BNF View SPC online View childrens BNF
Formulary
Red
Tablets 100mg
Consultant rheumatologist only.
Reserved for ankylosing spondylitis not responsive to other NSAIDs 
 
Diclofenac
(Rectal route)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green Restricted

Suppositories 12.5mg, 25mg, 50mg, 100mg

For short term treatment of post-op pain, renal colic and lithotripsy only

 
Link  MHRA: Diclofenac: new contraindications and warnings
 
Diclofenac
(Oral route)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green Restricted

Tablets e/c 25mg, 50mg
Dispersible tablets 50mg
 
Restricted ItemFor short term use in breastfeeding mothers only

 
Link  MHRA: Diclofenac: new contraindications and warnings
 
Diclofenac (Akis®)
(parenteral route)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Restricted ItemFor short term treatment of post-op pain (Akis®)
 

Injection 75mg/1mL

Morecambe bay only

 
Link  MHRA: https://www.gov.uk/drug-safety-update/diclofenac-new-contraindications-and-warnings
 
10.01.01  Expand sub section  Aspirin to top
10.01.02  Expand sub section  Corticosteroids
10.01.02.01  Expand sub section  Systemic corticosteroids
10.01.02.02  Expand sub section  Local corticosteroids injections
Methylprednisolone Acetate (Depo-Medrone®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 80mg/2mL, 120mg/3ml, 40mg/ml 

 
 
Methylprednisolone Acetate with Lidocaine (Depo-Medrone®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection
(Methylprednisolone 80mg/2mL with lidocaine 20mg/2mL)

 
 
Triamcinolone Acetonide (Adcortyl®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 10mg/1mL

Intra-articular/intra-dermal injection 
 
Triamcinolone Acetonide (Kenalog®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 40mg/1mL

Intra-articular/intramuscular injection 
 
Triamcinolone hexacetonide
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 20mg/mL

Second line to Kenalog® 
 
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
BimekizumabBlack Triangle (Bimzelx®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
BlueTeq

Pre-filled syringe/pen 160mg

 

ICB Commissioned

 
Link  NICE TA916: Bimekizumab for treating active psoriatic arthritis
Link  NICE TA918: Bimekizumab for treating axial spondyloarthritis
 
SarilumabBlack Triangle (Kevzara®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
BlueTeq

Pre-filled pen 150mg. 200mg
Pre-filled syringe 150mg, 200mg

 
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
 
10.01.03  Expand sub section  Gold to top
10.01.03  Expand sub section  Penicillamine
Penicillamine
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Tablets 125mg

 
Link  LSCMMG: Shared care guideline - Penicillamine
 
10.01.03  Expand sub section  Antimalarials
Hydroxychloroquine
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Tablets 200mg, 300mg

 
Link  LSCMMG: Hydroxychloroquine information sheet
 
10.01.03  Expand sub section  Drugs affecting the immune response
Abatacept (Orencia®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

Intravenous infusion 250mg
S/C injection 125mg prefilled syringe pre-filled pen 

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed
 
Adalimumab (Biosimilars avaliable)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

S/C injection 40mg prefilled syringe and pen

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA195:Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed
 
Anakinra (Kineret®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine

Solution for injection pre-filled syringes  100mg/0.67mL

 
Link  NICE TA685: Anakinra for treating Still’s disease
 
Apremilast
View adult BNF View SPC online View childrens BNF
Formulary
Red
BlueTeq

Tablets 10mg, 20mg, 30mg

 
Link  MHRA: Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
 
Cytotoxic Drug Azathioprine
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Tablets 25mg, 50mg

 
Link  LSCMMG: Shared care guideline - Azathioprine
 
Certolizumab Pegol (Cimzia®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
Homecare
BlueTeq

S/C injection 200mg prefilled syringe pre-filled pen 

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
 
Ciclosporin
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Capsules 25mg, 50mg, 100mg

 
Link  LSCMMG: Shared care guideline - Ciclosporin
 
Cytotoxic Drug Cyclophosphamide
View adult BNF View SPC online View childrens BNF
Formulary
Red
Tablets 50mg
Injection 200mg, 500mg, 1g

unlicensedunlicensed use 
 
Etanercept (Biosimilars avaliable)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

S/C injection 25mg, 50mg vial with diluent and prefilled syringe pre-filled pen 

usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA195:Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed
 
Golimumab (Simponi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
Homecare
BlueTeq

S/C injection 50mg, 100mg, prefilled syringe pre-filled pen 

Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA220: Golimumab for the treatment of psoriatic arthritis
Link  NICE TA225: Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
 
Guselkumab (Tremfya®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
CCG

Solution for injection in pre-filled pen 100mg/1ml

 
Link  NICE TA815: Guselkumab for treating active psoriatic arthritis after inadequate response to DMARDs
 
Infliximab (Biosimilars avaliable)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
BlueTeq

Intravenous infusion 100mg, 120mg/ml pre-filled pen

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Tumour necrosis factor alpha inhibitors
Link  NICE TA195:Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA715: Adalimumab, etanercept, infliximab and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs have failed
 
Ixekizumab
View adult BNF View SPC online View childrens BNF
Formulary
Red
BlueTeq

80mg solution for injection prefilled syringe; prefilled pen

 
Link  NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA718: Ixekizumab for treating axial spondyloarthritis
 
Leflunomide
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Tablets 10mg, 20mg

 
Link  LSCMMG: Shared care guideline - Leflunomide
 
Cytotoxic Drug Methotrexate (check local policy - branded generic available )
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Tablets 2.5mg

S/C 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 17.5mg, 20mg, 22.5mg, 25mg and 30mg


Methotrexate should be prescribed once weekly as a single dose on the same day each week.
If oral methotrexate is prescribed only use the 2.5 mg strength.

See hospital policy for prescribing and supply of oral methotrexate

 
Link  LSCMMG: Shared care guideline - Methotrexate
 
RisankizumabBlack Triangle (Skyrizi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
BlueTeq

solution for injection pre-filled syringes, solution for injection pre-filled pen 150mg/mL

 
Link  NICE TA803: Risankizumab for treating active psoriatic arthritis after inadequate response to DMARDs
 
Rituximab (rheumatology) (Biosimilars avaliable)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
BlueTeq

Concentrate for intravenous infusion 500mg/50mL


REQUIRES BLUETEQ APPROVAL

 
Link  NICE TA195:Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
 
Secukinumab
View adult BNF View SPC online View childrens BNF
Formulary
Red
BlueTeq

150mg/ml pre-filled pens/syringes

 
Link  NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA719: Secukinumab for treating non-radiographic axial spondyloarthritis
 
Tocilizumab (Biosimilars avaliable)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
BlueTeq

Concentrate for intravenous infusion (20mg/mL) 80mg, 200mg, 400mg vials

Soution for injection in pre-filled syringe 162mg

Solution for injection in pre-filled pen 162mg


Usually supplied to patients by a home delivery company

REQUIRES BLUETEQ APPROVAL

 
Link  MHRA: Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
 
Ustekinumab
View adult BNF View SPC online View childrens BNF
Formulary
Red
BlueTeq

Subcutaneous injection 45mg, 90mg prefilled syringes and 45mg/0.5ml vials

 
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
 
10.01.03  Expand sub section  Cytokine modulators
 note  Consultant Rheumatologist initiation only
Only to be prescribed in accordance with NICE Guidelines
BaricitinibBlack Triangle (Olumiant®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG
Homecare
BlueTeq

Tablets 2mg, 4mg

 
Link  Baricitinib (Olumiant▼): risk of venous thromboembolism
Link  MHRA: Baricitinib (Olumiant▼): increased risk of diverticulitis, particularly in patients with risk factors
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
 
Filgotinib Black Triangle (Jyseleca®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
CCG
BlueTeq

Tablets 100mg, 200mg

 
Link  NICE TA676: Filgotinib for treating moderate to severe rheumatoid arthritis
 
TofacitinibBlack Triangle (Xeljanz®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
BlueTeq

Tablets 5mg

MR Tablets 11mg

   CCG commissioned for TA547

 
Link  LSCMMG: Tofacitinib (Xeljanz▼): new measures to minimise risk of major adverse cardiovascular events and malignancies
Link  LSCMMG: Tofacitinib (Xeljanz▼): new measures to minimise risk of venous thromboembolism and of serious and fatal infections
Link  LSCMMG: Tofacitinib (Xeljanz▼): restriction of 10 mg twice-daily dose in patients at high risk of pulmonary embolism while safety review is ongoing
Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
Link  NICE TA543: Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
Link  NICE TA735: Tofacitinib for treating juvenile idiopathic arthritis
Link  NICE TA920: Tofacitinib for treating active ankylosing spondylitis
 
Upadacitinib Black Triangle (Rinvoq ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
CCG
Homecare
BlueTeq

Prolonged release tablets 15mg

Red For NICE TA665: upadacitinib for treating severe rheumatoid arthritis - see link below

Red For NICE TA768: Upadacitinib for treating active psoriatic arthritis after inadequate response to DMARDs - see link below

Red For NICE TA829: Upadacitinib for treating active ankylosing spondylitis - see link below 

Red For NICE TA861 Upadacitinib for treating active non-radiographic axial spondyloarthritis - see link below
 
 
 
 
Link  NICE TA665: Upadacitinib for treating severe rheumatoid arthritis
Link  NICE TA744: Upadacitinib for treating moderate rheumatoid arthritis
Link  NICE TA768: Upadacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
Link  NICE TA829: Upadacitinib for treating active ankylosing spondylitis
Link  NICE TA861: Upadacitinib for treating active non-radiographic axial spondyloarthritis
 
10.01.03  Expand sub section  Sulfasalazine to top
Sulfasalazine EC (Salazopyrin EN-Tabs®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

E/C tablets 500mg

Other dose forms of sulfasalazine - see section 1.5, non e/c tablets and liquid are not licensed for rheumatoid arthritis

 
Link  LSCMMG: Shared care guideline - Sulfasalazine
 
10.01.04  Expand sub section  Gout and cytotoxic-induced hyperuricaemia
LumasiranBlack Triangle (Oxlumo ®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Solution for injection  94.5mg/0.5mL

Red Tertiary Centre only for NICE HST25 Lumasiran for treating primary hyperoxaluria type 1 - See link below

 

 
Link  NICE: Lumasiran for treating primary hyperoxaluria type 1
 
10.01.04  Expand sub section  Acute attacks of gout
Colchicine
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 500 micrograms

 
Link  LSCMMG: Gout Management Summary Guidelines
 
10.01.04  Expand sub section  Long-term control of gout
Allopurinol
View adult BNF View SPC online View childrens BNF
First Choice
Green
Tablets 100mg, 300mg 
Febuxostat (Adenuric® )
View adult BNF View SPC online View childrens BNF
Second Choice
Green
Tablets f/c 80mg, 120mg

For patients who are intolerant of allopurinol or for whom allopurinol is contraindicated 
Link  LSCMMG: Gout Management Summary Guidelines
Link  MHRA: Febuxostat (Adenuric): increased risk of cardiovascular death and all-cause mortality in clinical trial in patients with a history of major cardiovascular disease
 
10.01.04  Expand sub section  Hyperuricaemia associated with cytotoxic drugs
Rasburicase (Fasturtec®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Intravenous infusion 7.5mg

Consultant haematologist only 
 
10.01.05  Expand sub section  Other drugs for rheumatic diseases to top
10.02  Expand sub section  Drugs used in neuromuscular disorders
AtalurenBlack Triangle (Translarna ®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
NHS England

Granules for oral suspension 1000mg, 125mg, 250mg

Ataluren for treating Duchenne muscular dystrphy with a nonsense mutation in the dystrophin gene (replaces HST3) - likely to be tertiary centre only

 
Link  NICE:Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene
 
Nusinersen Black Triangle (Spinraza®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Solution for injection vials 12mg/5ml

 
Link  NICE TA588: Nusinersen for treating spinal muscular atrophy
 
Onasemnogene abeparvovecBlack Triangle (Zolgensma® )
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

 2 × 1013 vector genomes/mL solution for infusion

Tertiary centre

 
Link  NICE: Onasemnogene abeparvovec for treating presymptomatic spinal muscular atrophy
Link  NICE: Onasemnogene abeparvovec for treating spinal muscular atrophy
 
Risdiplam Black Triangle (Evrysdi®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Powder for oral solution 0.75mg/mL

 
Link  NICE TA755: Risdiplam for treating spinal muscular atrophy
 
10.02.01  Expand sub section  Drugs which enhance neuromuscular transmission
10.02.01  Expand sub section  Anticholinesterases
Edrophonium Chloride
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 10mg/1mL 
 
Pyridostigmine Bromide
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Tablets 60mg

 
 
10.02.01  Expand sub section  Immunosuppressant therapy
10.02.01  Expand sub section  Acetylcholine-release enhancers to top
10.02.02  Expand sub section  Skeletal muscle relaxants
Baclofen
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 10mg
Liquid 5mg/5mL 
 
Controlled Drug Cannabis extract (Sativex®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Restricted to an initial 4-week trial for treatment of moderate to severe spasticity in adults with multiple sclerosis in line with NICE NG144. Treatment may be continued after the 4-week trial as long as the patient has had at least a 20% reduction in spasticity-related symptoms

 

Black  for Refractory neuropathic pain

 
Link  NICE NG144: Cannabis-based medicinal products
 
Dantrolene
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Capsules 25mg

 
 
Diazepam
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 2mg, 5mg, 10mg
Syrup 2mg/5mL
Injection 5mg/mL (2mL ampoules)
 
 
Mexiletine hydrochloride (Namuscla ® )
View adult BNF View SPC online View childrens BNF
Formulary
Red
NHS England

Capsules 167mg

 
Link  NICE TA748: Mexiletine for treating the symptoms of myotonia in non-dystrophic myotonic disorders
 
Tizanidine (Zanaflex®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber 0

Tablets 2mg, 4mg

Consultant initiation only

 
 
10.02.02  Expand sub section  Other muscle relaxants
10.02.02  Expand sub section  Nocturnal leg cramps
Quinine
View adult BNF View SPC online View childrens BNF
Formulary
Green
Tablets 200mg, 300mg 
Link  MHRA: Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
Link  Quinine for muscle cramps
 
10.03  Expand sub section  Drugs for the treatment of soft-tissue disorders and topical pain relief
10.03  Expand sub section  Extravasation to top
10.03.01  Expand sub section  Enzymes
Hyaluronidase (Hyalase®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection 1500 units 
 
10.03.02  Expand sub section  Rubefacients, topical NSAIDs, capsaicin, and poultices
 note 

Rubefacients (with the exclusion of topical NSAIDs and Capsaicin) are classified as BLACK as per national guidelines on items which should NOT routinely be prescribed in primary care.

Rubefacients
View adult BNF
Restricted Drug Restricted
Green

Rubefacients (excluding topical NSAIDs and capsaicin) are classified as BLACK (Not to be prescribed) as per national guidelines on items which should not routinely be prescribed in primary care.

Examples include: Algisal, Deep Heat, Transvasin

 

In hospital Deep Heat cream may be used for aiding the collection of arterial blood gases.

 
 
10.03.02  Expand sub section  Topical NSAIDs and counter-irritants
Ibuprofen 5 % gel
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Green

gel 5%

In Primary Care prescribe as Fenbid gel

 
 
Ibuprofen 10% gel
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Green

gel 10%

Primary Care only  - prescribe as Fenbid Forte gel

 
 
10.03.02  Expand sub section  Capsaicin
Capsaicin (Zacin ®)
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Do Not Prescribe

Cream 0.025%

This medicine has been assigned a temporary Do not prescribe RAG rating due to a temporary lack of availability.

 
 
Capsaicin (Axsain®)
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Do Not Prescribe

Cream 0.075%

This medicine has been assigned a temporary Do not prescribe RAG rating due to a temporary lack of availability.

 
 
Capsaicin (Qutenza®)
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Red

Patch 179mg (8%)

Treatment of peripheral neuropathic pain in adults either alone or in combination with other medicinal products for the treatment of pain.

Restricted Item For specialist use only

 
 
10.03.02  Expand sub section  Poultices to top
10.04  Expand sub section  Dibotermin
Dibotermin alfa (InductOs®)
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Red for acute tibia fractures in adults (licensed)

Do Not Prescribe for non-union long bone fractures (unlicensed)

 
 
10.05  Expand sub section  Devices
Therabite Jaw Rehabilitation Device (Therabite ®)
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Red
 
 
 ....
 Non Formulary Items
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Green Low Carbon

Low carbon footprint

Amber Medium Carbon

Medium carbon footprint

Red High carbon footprint

High carbon footprint

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Status Description

Green

Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.  

Green Restricted

Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.   

Red

Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.  

Amber 0

Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.  

Amber 1

Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.  

Amber 2

Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).  

Do Not Prescribe

Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.  

Grey

Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.   

Multiple

Refer to local guidance.  

netFormulary