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Birmingham, Sandwell, Solihull and environs APC Formulary
Maintained by Midlands and Lancashire Commissioning Support Unit
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
 note 
10.01.03  Expand sub section  Gold
10.01.03  Expand sub section  Penicillamine
10.01.03  Expand sub section  Antimalarials
10.01.03  Expand sub section  Drugs affecting the immune response to top
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 (Humira®)
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Restricted Drug Restricted
Red
High Cost Medicine
Hospital only 
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
 
   
Infliximab (Remicade®)
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Restricted Drug Restricted
Red
High Cost Medicine
Hospital only 
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  Expand sub section  Cytokine modulators
10.01.03  Expand sub section  Sulfasalazine
 ....
 Non Formulary Items
Cytotoxic Drug  Cyclophosphamide

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Non Formulary
 
  
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
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.  

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