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Birmingham, Sandwell, Solihull and environs APC Formulary
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01  Drugs used in rheumatic diseases and gout
10.01  Rheumatoid arthritis and other inflammatory disorders
10.01  Osteoarthritis and soft-tissue disorders
10.01.01  Non-steroidal anti-inflammatory drugs
Ibuprofen
(tablets)
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Formulary
Green
 
Link  UKMI Q&A: Can breastfeeding mothers take ibuprofen?
   
Ibuprofen
(suspension)
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Formulary
Green
  • For patients with swallowing difficulties
  • Paediatric use 
  •    
    Naproxen
    (plain tablets)
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    Formulary
    Green
  • NOT Enteric Coated tablets 
  •    
    Diclofenac
    (enteric coated tablets/ suppositories/ injection)
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    Formulary
    Green
  • Short term use only
  • assess CVD risk
  • Not first line NSAID
  • Renal colic and severe acute painful conditions 
  •    
    Diclofenac
    (dispersible tablets)
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    Formulary
    Green
    High Cost Medicine
  • Short term use only
  • assess CVD risk
  • Not first line NSAID
  • For patients with swallowing diffulties
  • Renal colic and severe acute painful conditions 
  •    
    Mefenamic Acid
    (capsules/ tablets)
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    Formulary
    Green
  • For dysmenorrhoea 
  •    
    Celecoxib
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    Formulary
    Amber

     

    • CVD risk assessment
     
       
    Indometacin
    (capsules/ MR capsules)
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    Formulary
    Amber
  • For gout and resistant cases 
  •    
    Indometacin
    (25mg/5ml oral suspension)
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    Formulary
    Amber
    High Cost Medicine
  • Special product (100ml)
  • For gout and resistant cases 
  •    
    Sulindac
    (tablets)
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    Formulary
    Red
  • For polyhydramnios (women only) 
  •    
    10.01.01  Aspirin to top
    10.01.02  Corticosteroids
    10.01.02.01  Systemic corticosteroids
    Prednisolone
    (Tablets (NOT enteric coated))
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    Formulary
    Green
     
       
    Prednisolone
    (Dispersible tablets)
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    Formulary
    Green
    for use in children or patients with swallowing difficulties  
       
    10.01.02.02  Local corticosteroids injections
    Hydrocortisone acetate (Hydrocortistab®)
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    Formulary
    Green
     
       
    Methylprednisolone Acetate (Depo-Medrone®)
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    Formulary
    Green
     
       
    Methylprednisolone Acetate/ Lidocaine (Depo-Medrone® with Lidocaine)
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    Formulary
    Green
     
       
    Triamcinolone Acetonide
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    Formulary
    Green
     
       
    10.01.03  Drugs which suppress the rheumatic disease process
     note 
    10.01.03  Gold to top
    Sodium Aurothiomalate (Myocrisin®)
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    Formulary
    Amber
    Supported by ESCA, see link below. 
    Link  ESCA: Sodium aurothiomalate in RA or PA.
       
    10.01.03  Penicillamine
    Penicillamine
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    Formulary
    Amber
    Supported by ESCA, see link below.  
    Link  ESCA: Penicillamine in RA.
       
    10.01.03  Antimalarials
    Hydroxychloroquine
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    Formulary
    Amber
    • Please note: ESCA is not required - Common practice
     
       
    10.01.03  Drugs affecting the immune response
    Cytotoxic Drug Azathioprine
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    Formulary
    Amber
    Supported by ESCA, see link below. 
    Link  ESCA: Azathioprine in RA or PA.
       
    Abatacept (Orencia®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Hospital only

    Available via Home Care 
    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 TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
       
    Adalimumab
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    • Hospital only
    • Biosimilar brands available:
      • Amgevita®
      • Hulio®
      • Imraldi®
      • Hyrimoz®
     
    Link  NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
    Link  NICE TA373: Juvenile idiopathic arthritis- abatacept, adalimumab, etanercept and tocilizumab
    Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
       
    Anakinra (Kineret®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Hospital only 
       
    Avelumab (Bavencio ®)
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    Restricted Drug Restricted
    Red
    NHS England

    In line with NICE

    Hospital only

     
    Link  NICE TA517: Avelumab for treating metastatic Merkel cell carcinoma
       
    Baricitinib ® (Olumiant)
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    Formulary
    Red
    High Cost Medicine
    In line with NICE 
    Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
       
    Brodalumab (Kyntheum ®)
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    Restricted Drug Restricted
    Red
    CCG

    In line with NICE

     

     
    Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
       
    Certolizumab Pegol (Cimzia®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    In line with NICE
    Hospital only

    Available via Home Care 
    Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
    Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
    Link  NICE TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
    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
       
    Ciclosporin
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    Formulary
    Amber
    Supported by ESCA, see link below. 
    Link  ESCA: Ciclosporin in RA or PA.
       
    Etanercept (Enbrel®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Hospital only 
    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 TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
    Link  NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis
    Link  NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
       
    Golimumab (Simponi®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    CCG

    Hospital only

    Available via Home Care

     
    Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
    Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
    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 TA225: Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs
    Link  NICE TA220: Golimumab for the treatment of psoriatic arthritis
       
    Hydroxychloroquine
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    Formulary
    Amber
     
    Link  Hydroxychloroquine and Chloroquine Retinopathy: The Royal College of Ophthalmologists Recommendations on Screening
       
    Infliximab
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    • Hospital only
    • Biosimilar brands available:
      • Flixabi®
      • Inflectra®
      • Remsima®
      • Zessly®
     
    Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed.
    Link  NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab
    Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
       
    Leflunomide
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    Formulary
    Amber
    Supported by ESCA, see link below.  
    Link  ESCA: Leflunomide in RA or PA.
       
    Cytotoxic Drug Methotrexate 2.5mg tablets
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    Formulary
    Amber
    Supported by ESCA, see link below.

    Should only be prescribed as 2.5mg tablets (Local agreement following National Patient Safety Agency alert) 
    Link  ESCA: Methotrexate in RA or PA.
    Link  NPSA: Improving compliance with oral methotrexate guidelines
    Link  UKMI Q&A: Methotrexate and alcohol guidance
       
    Cytotoxic Drug Metoject®
    (Methotrexate injection)
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    Formulary
    Amber
    Metoject is APC preferred brand in view of additional patient safety characteristics.
    Supported by ESCA, see link below.
    Check cytotoxic disposal arrangements locally 
    Link  ESCA: Methotrexate in RA or PA.
       
    Rituximab (rheumatology) (MabThera®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Hospital only 
    Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
    Link  NICE TA308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis
       
    Tocilizumab (RoActemra®)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Hospital only 
    Link  NICE TA518: Tocilizumab for treating giant cell arteritis
    Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed.
    Link  NICE TA373: Juvenile idiopathic arthritis- abatacept, adalimumab, etanercept and tocilizumab
    Link  NICE TA247: Rheumatoid arthritis - tocilizumab (rapid review TA198)
    Link  NICE TA238: Arthritis (juvenile idiopathic, systemic) - tocilizumab
       
    Ustekinumab (Stelara®)
    (Rheumatology)
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    Restricted Drug Restricted
    Red
    High Cost Medicine
    Hospital only 
    Link  NICE TA340: Active psoriatic arthritis- ustekinumab (rapid review of TA313)
       
    10.01.03  Cytokine modulators
    10.01.03  Sulfasalazine to top
    Sulfasalazine
    (Enteric coated tablets)
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    Formulary
    Amber
    Supported by ESCA, see link below. 
    Link  ESCA: Sulfasalazine in RA or PA.
       
    10.01.04  Gout and cytotoxic-induced hyperuricaemia
    10.01.04  Acute attacks of gout
    Colchicine
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    Formulary
    Green
     
       
    Prednisolone tablets
    (NOT enteric coated)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Second line gout treatment

     
       
    10.01.04  Long-term control of gout
    Allopurinol
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    Formulary
    Green
     
       
    Febuxostat (Adenuric®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Second line

     
    Link  NICE TA 164: Febuxostat for the management of hyperuricaemia in people with gout
       
    Probenecid
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
     
       
    10.01.04  Hyperuricaemia associated with cytotoxic drugs
    Rasburicase (Fastertec®)
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    Formulary
    Red
    • Hospital only
     
       
    10.01.05  Other drugs for rheumatic diseases to top
    10.02  Drugs used in neuromuscular disorders
    Nusinersen
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    Formulary
    Red
    NHS England
    • Use in line with NICE
     
    Link  NICE TA588: Nusinersen for treating spinal muscular atrophy
       
    10.02.01  Drugs which enhance neuromuscular transmission
    3,4,diaminopyridine
    ((3,4-DAP))
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Hospital only 
       
    10.02.01  Anticholinesterases
    Neostigmine tablets
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    Formulary
    Amber
     
    Link  UKMI Q&A: Converting between Pyridostigmine & Neostigmine
       
    Pyridostigmine Bromide
    (Tablets)
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    Formulary
    Amber
     
    Link  UKMI Q&A: Converting between Pyridostigmine & Neostigmine
       
    Edrophonium Chloride
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    Restricted Drug Restricted
    Red
    Hospital only 
       
    Neostigmine injection
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Hospital only 
       
    10.02.01  Immunosuppressant therapy
    Mycophenolate mofetil
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    Formulary
    Amber
    High Cost Medicine
    • For use in connective tissue diseases
    • For specialist initiation and dose stabilisation.
    • Supported by an ESCA.

     
    Link  ESCA: Mycophenolate in connective tissue disease
       
    Tofacitinib (Xeljanz®)
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    Formulary
    Red
    CCG

    In line with NICE

     
    Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
    Link  NICE TA543: Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
       
    10.02.01  Acetylcholine-release enhancers to top
    10.02.02  Skeletal muscle relaxants
    Baclofen
    (Tablets, SF Liquid)
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    Formulary
    Green
     
       
    Diazepam
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    Tizanidine tablets
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
     
       
    Dantrolene capsules
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    Formulary
    Amber
     
       
    Baclofen intrathecal
    (injection)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Hospital only 
       
    10.02.02  Other muscle relaxants
    10.02.02  Nocturnal leg cramps
    Quinine sulphate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Short term use only- MHRA guidance 
    Link  MHRA: Quinine: not to be used routinely for nocturnal leg cramps
       
    10.03  Drugs for the treatment of soft-tissue disorders and topical pain relief
    10.03  Extravasation to top
    10.03.01  Enzymes
    Collagenase clostridium histolyticum (Xiapex®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    In line with NICE 
    Link  NICE TA459: Collagenase clostridium histolyticum for treating Dupuytren’s contracture
       
    10.03.02  Rubefacients, topical NSAIDs, capsaicin, and poultices
     note 

    Rubefacients (excluding topical NSAIDs) should NOT be routinely prescribed in Primary Care and are NON-FORMULARY. 

    This is in line with NHS England's Guidance, see link below: 

    10.03.02  Topical NSAIDs and counter-irritants
    Ibuprofen gel
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    Formulary
    Green
     
       
    10.03.02  Capsaicin
    Capsaicin cream
    (0.025%)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tier 2 , £££
     
       
    Capsaicin cream
    (0.075%)
    View adult BNF View SPC online View childrens BNF
    Formulary see chapter 4.7.3 for neuropathic pain

     
       
    10.03.02  Poultices to top
    10.04  Drugs for digital ulceration
    Sildenafil tablets GENERIC
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
  • Use in digital ulceration is commissioned by NHS England
  • All prescribing retained in Secondary Care
  • Off label use 
  •    
     ....
     Non Formulary Items
    Acelofenac  (Preservex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Acemetacin  (Emflex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • Discontinued
  •  
    Algesal

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Link  Patient Information Leaflet
     
    Amifampridine  (Firdapse)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Auranofin  (Ridaura®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Azapropazone  (Rheumox®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Benzbromarone

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Update following APC harmonisation
     
    Betamethasone  (Betnesol®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Controlled Drug  Cannabis extract  (Sativex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Capsaicin Patch  (Qutenza®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Carisoprodol  (Carisoma®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Chloroquine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Cytotoxic Drug  Cyclophosphamide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dexamethasone

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dexamethasone Phosphate

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dexibuprofen  (Seractil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dexketoprofen  (Keral®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Diclofenac  (Mobigel®, Voltarol Emugel®, Voltarol Gel Patch®, Pennsaid)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Diclofenac Sodium
    (all Modified Release formulations)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Diclofenac with Misoprostol  (Arthrotec 50 and 75®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Distigmine Bromide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Discontinued
     
    Etodolac

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Etoricoxib  (Arcoxia®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Felbinac  (Traxam®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fenbufen

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    Non Formulary
     
    Fenoprofen  (Fenopron®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Flurbiprofen

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Flurbiprofen

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Glucosamine

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • In line with NHS England's Guidance for CCGs: Items which should not routinely be prescribed in primary care (Dec 2017)

    Click here to access guidance
  • Link  Patient Information Leaflet
    Link  UKMI Q&A: Glucosamine - drug interactions
    Link  UKMI Q&A: Glucosamine - what are the adverse effects?
    Link  UKMI Q&A: Glucosamine in renally impaired patients
     
    Glucosamine and chondroitin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
  • In line with NHS England’s Guidance for CCGs: Items which should not routinely be prescribed in primary care (Dec 2017)
    Click here to access guidance
  • Link  Patient Information Leaflet
     
    Hyaluronic acid  (Hyalgan®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Hyaluronidase  (Hyalase®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Hylan G-F 20  (Synvisc®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ibuprofen
    (Modified Release formulations)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Ibuprofen and famotidine  (Duexis®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Indometacin
    (suppositories)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Kaolin Poultice

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Kaolin Poultice  (Kaolin Poultice K/L Pack®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ketoprofen

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ketoprofen  (Oruvail®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ketoprofen  (Oruvail® MR)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ketoprofen 2.5%  (Oruvail ®, Powergel®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lumiracoxib  (Prexige®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meloxicam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Meloxicam  (Mobic®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Methocarbamol  (Robaxin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Movelat  (Topical gel / cream)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Link  Patient Information Leaflet
     
    Nabumetone

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    Non Formulary
    Black
     
    Nabumetone  (Relifex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Naproxen
    (Enteric coated tablets)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Naproxen & esomeprazole  (Vimovo®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Naproxen with Misoprostol  (Napratec®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Piroxicam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Piroxicam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Piroxicam  (Brexidol®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Piroxicam  (Feldene®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
     
    Prednisolone Acetate  (Deltastab®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sulfinpyrazone

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sulindac  (Clinoril®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tenoxicam  (Mobiflex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tiaprofenic Acid

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tiaprofenic Acid  (Surgam®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Transvasin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Link  Patient Information Leaflet
     
      
    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
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    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

    Traffic Light Status Information

    Status Description

    Prescribing in children

    The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

    The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.

      

    Green

    Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications.  

    Amber

    Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.

    Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements.   

    Red

    Medicines for initiation and maintenance prescribing by Specialists only  

    Black

    Non-formulary medicines- medicines not recommended for routine primary care prescribing.  

    Grey

    Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information.  

    netFormulary