netFormulary Central Lancashire Formulary NHS
Lancashire Teaching Hospitals NHS Foundation Trust
Chorley and South Ribble CCG
Greater Preston CCG
 
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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
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Purple

Drug included within CCG low priority prescribing policy. EXEMPTIONS EXIST FOR CERTAIN INDICATIONS. Please consult attached policy for list of excepted indications for prescribing of this drug

 
Link  Drug Safety Update June 2015: High-dose ibuprofen (≥2400mg/day): small increase in cardiovascular risk
   
Naproxen
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Green
 
   
Indometacin
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Green
 
   
Mefenamic Acid
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Green
 
   
Diclofenac
(Suppositories ONLY)
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Green
 
   
Diclofenac
(ORAL)
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Restricted Drug Restricted
Green
Green restricted - ensure cardiovascular risk assessment is conducted prior to prescribing. Not to be initiated in secondary care. 
   
Etoricoxib
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Green

Arcoxia®

 
   
10.01.01  Aspirin to top
10.01.02  Corticosteroids
10.01.02.01  Systemic corticosteroids
10.01.02.02  Local corticosteroids injections
Hydrocortisone acetate
(Intra-Articular Injection)
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Red

Hydrocortistab®

 
   
Methylprednisolone Acetate
(Intra-articular Injection)
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Red

Depo-Medrone®

Depo-Medrone® with Lidocaine

 
   
Triamcinolone Acetonide
(Intra-articular Injection)
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Red

Adcortyl®

Kenalog®

 
   
10.01.03  Drugs which suppress the rheumatic disease process
10.01.03  Gold to top
Soldium Aurothomalate
(Gold)
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Amber 2

Myocrisin®

 
   
10.01.03  Penicillamine
Penicillamine
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Amber 2
 
   
10.01.03  Antimalarials
Hydroxychloroquine
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Amber
 
   
10.01.03  Drugs affecting the immune response
Abatacept
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Red
High Cost Medicine
BlueTeq

Orencia®

 
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
   
Adalimumab
(rheumatology)
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Red
High Cost Medicine
BlueTeq

Humira®

 
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: 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
   
Cytotoxic Drug Azathioprine
(rheumatology)
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Amber 2
 
   
Certolizumab Pegol
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Red
High Cost Medicine
BlueTeq

Cimzia®

 
Link  NICE TA375: 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 TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
   
Ciclosporin
(rheumatology)
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Amber 2
 
   
Etanercept
(rheumatology)
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Red
High Cost Medicine
BlueTeq

Enbrel®

 
Link  NICE TA35: Adult psoriasis
Link  NICE TA195: Rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for JIA
Link  NICE TA375: 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
   
Golimumab
(rheumatology)
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Red
High Cost Medicine
BlueTeq

Simponi®

 
Link  NICE TA220: psoriatic arthritis
Link  NICE TA375: 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
   
Infliximab
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Red
High Cost Medicine
BlueTeq

Remicade®; Remsima

 
Link  NICE TA195: Rheumatoid arthritis (after failure of a TNF inhibitor)
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA375: 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
   
Leflunomide
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Amber 2
 
   
Cytotoxic Drug Methotrexate
(rheumatology)
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Amber 2
 
   
Tocilizumab
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Red
High Cost Medicine
BlueTeq

RoActemra®

 
Link  NICE TA247:Tocilizumab in RA
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  Drug Safety Update July 2019 Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation
   
Ustekinumab
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Red
BlueTeq

Stelara®

 
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
   
10.01.03  Cytokine modulators
10.01.03  Sulfasalazine to top
Sulfasalazine
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Amber 2
 
   
10.01.04  Gout and cytotoxic-induced hyperuricaemia
10.01.04  Acute attacks of gout
Colchicine
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Green
 
   
10.01.04  Long-term control of gout
Allopurinol
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Green
 
   
Febuxostat
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Restricted Drug Restricted
Green

Adenuric®

 
Link  NICE TA164: Hyperuricaemia - febuxostat
Link  Drug Safety Update July 2019: 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  Hyperuricaemia associated with cytotoxic drugs
Rasburicase
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Red
High Cost Medicine

Fasturtec®

 
   
10.01.05  Other drugs for rheumatic diseases to top
10.02  Drugs used in neuromuscular disorders
Ataluren
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Red
High Cost Medicine
NHS England
BlueTeq

Translarna®

Treatment of nonsense mutation Duchenne muscular dystrophy (nmDMD)

 
   
10.02.01  Drugs which enhance neuromuscular transmission
10.02.01  Anticholinesterases
Edrophonium Chloride
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Red
 
   
Neostigmine
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Amber
 
   
Pyridostigmine Bromide
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Amber

Mestinon®

 
   
10.02.01  Immunosuppressant therapy
10.02.01  Acetylcholine-release enhancers to top
10.02.02  Skeletal muscle relaxants
Diazepam
(muscle relaxant)
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Green
 
   
Baclofen
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Green
 
   
Dantrolene
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Amber
 
   
Tizanidine
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Amber
 
   
10.02.02  Other muscle relaxants
10.02.02  Nocturnal leg cramps
Quinine
(cramps)
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Green
 
Link  Drug Safety Update November 2017: Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
   
10.03  Drugs for the treatment of soft-tissue disorders and topical pain relief
10.03  Extravasation to top
10.03.01  Enzymes
Hyaluronidase (Hyalaseģ)
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Red
 
   
10.03.02  Rubefacients, topical NSAIDs, capsaicin, and poultices
10.03.02  Topical NSAIDs and counter-irritants
Ibuprofen gel
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Green

5%

 
   
Deap Heat Rub
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Restricted Drug Restricted
Red

For capillary blood gas testing only

 
   
10.03.02  Capsaicin
10.03.02  Poultices to top
 ....
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
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

Traffic Light Status Information

Status Description

Amber

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.  

Amber 1

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 patientís on-going care must be reached under the shared care agreement.  

Amber 2

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 patientís on-going care must be reached under the shared care agreement. Suitable for enhanced service.  

Black

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

Blue

Products shown as blue have different Traffic Light List classifications dependent on indication. See the accompanying text next to the product for further information  

Green

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

Purple

Low Priority for Prescribing - see Low Priority for Prescribing Policy  

Red

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 Specialist Centre

Prescribing restricted to Specialist Centres only  

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