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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01  Drugs used in rheumatic diseases and gout
Belimumab
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Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal but is not listed in the Trust Medicines Formulary as the service is not offered at NMUH - for intiation at specialist centres.
    • See MHRA Drug Safety Update.
  • RFL:
    • Approved for use in the treatment of SLE in line with NICE guidance
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE technology appraisal.
    • See link below.
 
Link  NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
10.01  Rheumatoid arthritis and other inflammatory disorders
10.01  Osteoarthritis and soft-tissue disorders
10.01.01  Non-steroidal anti-inflammatory drugs
Celecoxib
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • For Rheumatology use only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Diclofenac sodium
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Provider notes

  • NMUH:
    • See MHRA Drug Safety Update
  • RFL:
    • Restricted to Rheumatology, Obstetricians / Gynaecology and Paediatrics (suppositories or injection)
    • Injection, Suppositories 12.5mg/25mg/100mg, EC tablets 25mg/50mg 
  • RNOH:
    • Restricted: Diclofenac treatment should only be initiated after careful consideration for patients with significant risk factors for cardiovascular events (eg, hypertension, hyperlipidaemia, diabetes mellitus, smoking).
  • UCLH:
  • WH:
    • See MHRA Drug Safety Update
 
Diclofenac sodium + Misoprostol
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Must not be given to women of child-bearing potential
 
Diclofenac sodium modified release
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Provider notes

  • NMUH:
    • Non-formulary
    • Check MHRA Drug Safety Updates 
  • RFL:
    • Restricted to only Rheumatology and Obs / Gynae
    • M/R tablets 75mg and 100mg available
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • See MHRA Drug Safety Update
 
Etodolac
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Provider notes

  • NMUH:
    • Restricted to use by Rheumatology Consultants only
  • RFL:
    • Restricted to use by Rheumatology only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Rheumatology only
 
Etodolac modified release
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Provider notes

  • NMUH:
    • Restricted to use by Rheumatology Consultants only
  • RFL:
    • Restricted to use by Rheumatology only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Rheumatology only
 
Etoricoxib
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Provider notes

  • NMUH:
    • Non-formulary
    • Check MHRA Drug Safety Updates 
  • RFL:
    • Restricted to use by Rheumatology only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Ibuprofen immediate release
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Provider notes

  • NMUH:
    • See MHRA Drug Safety Update
  • RFL:
    • No restriction stated
  • RNOH:
    • First choice NSAID
  • UCLH:
  • WH:
    • Intravenous injection restricted to Consultant level
 
Indometacin immediate release caps
(Analgesic)
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Provider notes

  • NMUH:
    • See link below
  • RFL:
    • Restricted to Neurology
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NMUH: Guideliens on Management of Acute and Chronic Gout
Indometacin modified release caps
(Analgesic)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Restricted to Neurology
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Restricted to Rheumatology only
 
Mefenamic acid
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Provider notes

  • NMUH:
    • Non-formulary
    • See link below
  • RFL:
    • Restricted to Gynaecology
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NMUH: Treatment Options for Primary Dysmenorrhoea and Menorrhagia
Meloxicam
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to use by Rheumatology only
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Restricted to Rheumatology only
 
Naproxen
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Second choice NSAID
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NMUH: Trust guidelines on Management of Acute and Chronic Gout
Piroxicam
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to Rheumatology only
    • 10mg capsules available.
  • RNOH:
    • Non-formulary  
  • UCLH:
  • WH:
    • Only piroxicam 0.5% gel
 
Sulindac
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Approved as first line treatment for oestrogen receptor-negative, desmoid-type fibromatosis for patients with slowly progressive, unresectable disease. Specialist initiation only (July 2014)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary  
  • UCLH:
  • WH:
    • No restriction stated
 
Acemetacin
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Rheumatology only.
 
10.01.01  Aspirin to top
10.01.02  Corticosteroids
10.01.02.01  Systemic corticosteroids
10.01.02.02  Local corticosteroids injections
Betamethasone
(Local Injection)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary  
  • UCLH:
  • WH:
    • No restriction stated
 
Dexamethasone
(Local Injection)
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated  
  • UCLH:
  • WH:
    • No restriction stated
 
Hydrocortisone acetate
(Local Injection)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated  
  • UCLH:
  • WH:
    • No restriction stated
 
Methylprednisolone acetate
(Depo-Medrone®)
(Local Injection)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated 
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NMUH: Guidelines on Management of Acute and Chronic Gout
Methylprednisolone acetate + Lidocaine injection
(Depo-Medrone® with Lidocaine)
(Local inflammation of joints and soft tissues)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated 
  • UCLH:
  • WH:
    • No restriction stated
 
Prednisolone acetate
(Local Injection)
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Triamcinolone acetonide
(Adcortyl®)
(Local Injection: Intra-articular/ Intradermal)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Triamcinolone acetonide
(Kenalog®)
(Local Injection: Intra-articular/ Intramuscular)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Triamcinolone hexacetonide
(Local Injection)
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Restricted for paediatric use ONLY.
    • See additional notes below.
  • UCLH:
  • WH:
    • No restriction stated

Additional notes:

  • Ampoules must be inspected for discolouration of the contents prior to administration.
  • Shake gently before use.
  • If necessary, Triamcinolone Hexacetonide may be mixed with 1% or 2% lidocaine hydrochloride. It must be drawn into the syringe before drawing in the anaesthetic to prevent contamination. The syringe should then be shaken gently, and the resulting solution used immediately thereafter.
 
10.01.03  Drugs which suppress the rheumatic disease process
10.01.03  Gold to top
Sodium Aurothiomalate
(Gold)
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Provider notes

  • NMUH:
    • Restricted for Rheumatology use only
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
10.01.03  Penicillamine
Penicillamine
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
10.01.03  Antimalarials
Chloroquine
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Hydroxychloroquine
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Restricted to Rheumatology Consultants Only
    • See links below
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
Link  RNOH + Herts CCG: Adult Rheumatology Shared Care - Principles and Responsibilities
Link  RNOH + Herts CCG: Hydroxychloroquine in Adult Rheumatology - Shared Care Information
10.01.03  Drugs affecting the immune response
Azathioprine
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY
    • See links below
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
Link  RNOH + Herts CCG: Adult Rheumatology Shared Care - Principles and Responsibilities
Link  RNOH + Herts CCG: Azathioprine in Adult Rheumatology - Shared Care Information
Ciclosporin
(Rheumatology)
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NOTE: There is more than one monograph for Ciclosporin, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Deximune® is the preferred brand
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY
    • See links below
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
Link  RNOH + Herts CCG: Adult Rheumatology Shared Care - Principles and Responsibilities
Link  RNOH + Herts CCG: Ciclosporin in Adult Rheumatology - Shared Care Information
Cyclophosphamide
(Scleroderma, Vasculitis, SLE, Sarcoid)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for use in Scleroderma (lung fibrosis), Vasculitis, SLE and Sarcoid
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Leflunomide
(Rheumatology)
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Provider notes

  • NMUH: 
    • Restricted to Rheumatology Consultants ONLY
  • RFL:
    • No restriction stated
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY
    • See links below
  • UCLH:
  • WH:
    • Restricted to Rheumatology Consultants ONLY
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  RNOH + Herts CCG: Adult Rheumatology Shared Care - Principles and Responsibilities
Link  RNOH + Herts CCG: Leflunomide in Adult Rheumatology - Shared Care Information
Methotrexate SC / IM injection
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

The licensed routes of administration for parenteral preparations vary—further information can be found in the product literature for the individual preparations.

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Metoject brand available in a variety of strengths
    • See pharmacy policy for the safe dispensing of methotrexate
  • RNOH:
    • Rheumatology Consultants ONLY
    • Metoject and Nordimet (if autoinjector required) brand
    • See links below
  • UCLH:
  • WH:
    • No restriction stated
 
Link  RNOH + Herts CCG: Adult Rheumatology Shared Care - Principles and Responsibilities
Link  RNOH + Herts CCG: Methotrexate in Adult Rheumatology - Shared Care Information
Methotrexate tablets
(Rheumatology)
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NOTE: There is more than one monograph for Methotrexate, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • See links below.
  • RFL:
    • 2.5mg tablets only
    • See pharmacy policy for safe dispensing of methotrexate
  • RNOH:
    • Restricted for Rheumatology Consultants ONLY
    • 2.5mg tablets ONLY
    • See links below
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NCL JFC: Shared care Guideline - Prescribing and Monitoring of oral methotrexate for licensed and off-label indications
Link  RNOH + Herts CCG: Adult Rheumatology Shared Care - Principles and Responsibilities
Link  RNOH + Herts CCG: Methotrexate in Adult Rheumatology - Shared Care Information
10.01.03  Cytokine modulators
Abatacept
(Rheumatology)
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High Cost Medicine
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Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Juvenile Idiopathic Arthritis (JIA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed by Rheumatologists ONLY.
    • Check MHRA Drug Safety Updates.
    • See links below.
  • RFL:
    • Approved for Rheumatoid Arthritis and Juvenile Idiopathic Arthritis, in line with NICE guidance
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY.
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA375: 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
(Rheumatology)
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High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Juvenile Idiopathic Arthritis (JIA; see NICE TA)
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic Arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH: 
    • Check MHRA Drug Safety Updates
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted to Consultant Rheumatologists
    • See links below
  • RFL:
    • Approved for use in Psoriatic Arthritis, Rheumatoid Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis
  • RNOH:
    • Restricted to Rheumatology Consultants Only
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
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
Anakinra
(Adult onset Stills disease)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for adult-onset Stills disease in line with NHSE commissioning policy (JFC October 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for AOSD in line with NHSE policy (see below)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE 170056P: Anakinra/tocilizumab for the treatment of Adult-Onset Still’s Disease refractory to second-line therapy (adults)
Apremilast
(Rheumatology)
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GP - Red
High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Psoriatic Arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed by Rheumatologists ONLY
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • As per NICE guidance for PsA
  • RNOH:
    • Rheumatology Consultants ONLY
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
Baricitinib
(Rheumatology)
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Approved for:

  • Rheumatoid arthritis (see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines - TO AWAIT UPDATED NCL JFC PATHWAY PRIOR TO PRESCRIBING
    • See link below
  • RFL:
    • As per NICE guidance for the treatment of RA
  • RNOH:
    • Rheumatology Consultants Only
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
Certolizumab pegol
(Rheumatology)
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GP - Red
High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines (see links below).
    • Restricted to Consultant Rheumatologists
    • See MHRA Drug Safety Update.
    • See links below.
  • RFL:
    • Approved for Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance.
  • RNOH:
    • Restricted for Rheumatology Consultants ONLY.
    • See links below.
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
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
Link  NICE TA445 : Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARD
Etanercept
(Rheumatology)
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GP - Red
High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

JFC approved Benepali as the brand of choice.

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Juvenile Idiopathic Arthritis (JIA; see NICE TAs below)
  • Ankylosing spondylitis (see NICE TAs below)
  • Psoriatic Arthritis (PsA; see NICE TAs below)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists
    • See MHRA Drug Safety Update
    • See links below
  • RFL:
    • Approved for use in Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance
  • RNOH:
    • Rheumatology Consultants ONLY
    • Please prescribe by brand name Benepali or Enbrel - patients requiring 50 mg should be prescribed Benepali and patients requiring 25 mg should be prescribed Enbrel
    • See links below
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
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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Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic Arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • Restricted to Rheumatology
    • Approved for use in Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance
  • RNOH:
    • Rheumatology Consultants ONLY.
  • UCLH:
  • WH
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA220: psoriatic arthritis
Link  NICE TA225: Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
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
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Remsima is the brand of choice

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic Arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted to Consultant Rheumatologists
    • See links below.
    • Check MHRA Drug Safety Updates.
  • RFL:
    • Approved for use in Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance
    • Approved for sarcoid (seek pharmacy advice)
    • Approved for Bechets disease (see pharmacy advice)
  • RNOH:
    • Restricted for Rheumatology Consultants ONLY.
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
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
Ixekizumab injection
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • As per NICE guidance for the treatment of Psoriatic Arthritis
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
Rituximab
(Rheumatology, Vasculitis)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Truxima brand is first choice (JFC March 2017).

Approved for:

  • Rheumatoid Arthritis; in line with the NCL RA pathway, including as monotherapy when methotrexate is C/I or not tolerated (July 2013)
  • ANCA associated vasculitis; in line with NHS England Commissioning Policy (May 2015)
  • Myositis (dermatomyositis and polymyositis); in line with NHS England Commissioning policy (September 2016)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • See links below
    • See MHRA Drug Safety Update
  • RFL:
    • Approved for use in rheumatoid arthritis, inflammatory myopathies, vasculitis and SLE
    • Seek advice from pharmacy prior to initiating treatment
    • See links below
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY
    • See links below
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NHSE 16036/P: Rituximab for the treatment of dermatomyositis and polymyositis (adults)
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  NICE TA308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis
Link  NHSE A13/P/a: Rituximab for the treatment of ANCA-associated vasculitis in adults
Sarilumab
(Rheumatology)
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See links below

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines - TO AWAIT UPDATED NCL JFC PATHWAY PRIOR TO PRESCRIBING
    • See links below
  • RFL:
    • As per NICE guidance
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA and NCL JFC pathway
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
Secukinumab
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Ankylosing Spondylitis (see NICE TA)
  • Psoriatic arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists 
    • See links below
  • RFL:
    • Approved for use in the treatment of Ankylosing Spondylitis and Psoriatic Arthritis in line with NICE guidance
  • RNOH:
    • Rheumatology Consultants ONLY
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
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
Tocilizumab
(Rheumatology, Vasculitis)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway (including without methotrexate [July 2013])
  • Juvenile Idiopathic Arthritis (JIA; see NICE TA)
  • Giant Cell Arteritis (see NICE TA)
  • Takayasu Arteritis - for RFL ONLY (JFC June 2017)
  • Adult-onset Stills disease in line with NHSE commissioning policy 170056P (JFC October 2018)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists
    • See MHRA Drug Safety Update
    • See links below
  • RFL:
    • Approved for Rheumatoid arthritis, Adult Onset Stills Disease (AOSD), Juvenile Idiopathic Arthritis, Giant Cell Arteritis and Takayasu Arteritis
  • RNOH:
    • Rheumatology Consultants ONLY
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NHSE 170056P: Anakinra/tocilizumab for the treatment of Adult-Onset Still’s Disease refractory to second-line therapy (adults)
Link  NICE TA238: Tocilizumab for the treatment of systemic juvenile idiopathic arthritis
Link  NICE TA247: Tocilizumab for the treatment of rheumatoid 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 TA518: Tocilizumab for treating giant cell arteritis
Link  NHSE 16056/P: Tocilizumab for Takayasu arteritis (adults)
Tofacitinib tabs
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis (see NICE TA)
  • Psoriatic Arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines - TO AWAIT UPDATED NCL JFC PATHWAY PRIOR TO PRESCRIBING
    • See links below
  • RFL:
    • Approved for the use of Rheumatoid Arthritis and Psoriatic Arthritis in line with NICE guidance
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
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  Tofacitinib - MHRA Drug Safety Update
Ustekinumab
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Psoriatic Arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists 
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • Psoriatic Arthritis in line with NICE guidance
  • RNOH:
    • Rheumatology consultants ONLY
    • See links below
  • UCLH:
  • WH:
    • As per NICE TA and above
    • Also see dermatology monograph

 

 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
10.01.03  Sulfasalazine to top
Sulfasalazine
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Note: Enteric coated tablets ONLY are licensed for rheumatoid arthritis and therefore recommended however the non-enteric coated preparation is used off-label in practice.

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Rheumatology initiation only
  • RNOH:
    • Enteric coated tablets ONLY for Rheumatology patients
    • Restricted use
    • See links below
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NCL JFC: DMARD Quick Reference Guide for Primary Care Prescribers
Link  RNOH + Herts CCG: Adult Rheumatology Shared Care - Principles and Responsibilities
Link  RNOH + Herts CCG: Sulfasalazine in Adult Rheumatology - Shared Care Information
10.01.04  Gout and cytotoxic-induced hyperuricaemia
10.01.04  Acute attacks of gout
Colchicine
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Provider notes

  • NMUH:
    • See link(s) below
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NMUH: Management of Acute and Chronic Gout
10.01.04  Long-term control of gout
Allopurinol
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Provider notes

  • NMUH:
    • See link(s) below
  • RFL:
    • No restriction stated
  • RNOH:
    • First choice for long-term control of gout
  • UCLH:
  • WH:
    • No restriction stated
 
Link  NMUH: Management of Acute and Chronic Gout
Febuxostat
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Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted to Consultant Rheumatologists or under the direction of a Consultant Rheumatologist.
    • See links below
  • RFL:
    • Restricted to Consultant Rheumatologists in line with NICE TA
  • RNOH:
    • See link below
  • UCLH:
  • WH:
    • As per NICE TA
 
Link  NICE TA164: Hyperuricaemia - febuxostat
Link  NMUH: Guidelines on Management of Acute and Chronic Gout
Probenecid
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Sulfinpyrazone
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
10.01.04  Hyperuricaemia associated with cytotoxic drugs
Rasburicase
(Haematology)
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JFC approved for tumour lysis syndrome in adults restricted to patients unable to tolerate allopurinol. Consideration for paediatric cases. (February 2013)

Provider notes

  • NMUH:
    • To be prescribed by the Haematology Team ONLY.
    • See link(s) below
    • Refer to the London Cancer Alliance Guidelines for Treatment of Tumour Lysis Syndrome
  • RFL:
    • Approved for prophylaxis and treatment of tumour lysis syndrome. Refer to regional protocol for more information
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to Haematology only
 
Link  NMUH: Prophylaxis of tumour lysis syndrome
10.01.05  Other drugs for rheumatic diseases to top
10.02  Drugs used in neuromuscular disorders
10.02.01  Drugs which enhance neuromuscular transmission
10.02.01  Anticholinesterases
Neostigmine bromide
(Myasthenia gravis)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Neostigmine methylsulfate 2.5mg/ml injection available
 
Pyridostigmine bromide
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary  
  • UCLH:
  • WH:
    • No restriction stated
 
10.02.01  Immunosuppressant therapy
10.02.01  Acetylcholine-release enhancers to top
10.02.02  Skeletal muscle relaxants
Baclofen oral
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Oral liquid available as 5 mg/5mL
  • UCLH:
  • WH:
    • No restriction stated
 
Dantrolene sodium
(Muscle relaxant)
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Provider notes

  • NMUH:
    • Check MHRA Drug Safety Update
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Diazepam
(Muscle relaxant)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Stored and supplied as a controlled drug on ITU, CHDU, Philip Newman ward and Ian Munroe ward
    • Oral solution available as 2 mg/5mL
  • UCLH:
  • WH:
    • No restriction stated
 
Tizanidine
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Provider notes

  • NMUH:
    • For continuation of treatment. NOT to be initiated at NMUHT.
  • RFL:
    • Approved for use by Neurologists ONLY.
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Baclofen intrathecal
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Unlicensed Drug Unlicensed
GP - Red
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Unlicensed - Intrathecal baclofen 1000 micrograms/mL, 2000 micorgrams/mL and 3000 micrograms/mL are unlicensed products
  • UCLH:
  • WH:
    • Non-formulary
 
10.02.02  Other muscle relaxants
Methocarbamol
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
10.02.02  Nocturnal leg cramps
Quinine
(Nocturnal leg cramps)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
10.03  Drugs for the treatment of soft-tissue disorders and topical pain relief
10.03  Extravasation to top
10.03.01  Enzymes
Hyaluronidase
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JFC approved for epidurolysis (epidural lysis of adhesions, adhesiolysis) for the treatment of chronic pain in patients presenting with radicular pain (JFC October 2016)

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
10.03.02  Rubefacients, topical NSAIDs, capsaicin, and poultices
10.03.02  Topical NSAIDs and counter-irritants
Felbinac 3% gel
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted to the Rheumatology team ONLY
    • Available over the counter without a prescription
 
Ibuprofen 5 % gel
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Piroxicam 0.5% gel
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • First-line topical NSAID
 
10.03.02  Capsaicin
Capsaicin cream
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Provider notes

  • NMUH: 
    • 0.025% NON FORMULARY
    • 0.075% restricted to pain clinic use ONLY
  • RFL: 
    • 0.075% strength kept for neuropathic pain
    • 0.025% is non-formulary
  • RNOH:
    • 0.025% restricted for use in accordance with the NICE guideline for osteoarthritis
    • See link(s) below
    • 0.075% NON FORMULARY
  • UCLH:
  • WH:
    • 0.025% restricted to the Rheumatology team. This strength of capsaicin cream is indicated for osteoarthritis only.
    • 0.075% restricted to pain clinic ONLY
 
Capsaicin patch
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JFC approved for neuropathic pain (January 2013)

Provider notes

  • NMUH:
    • Non-formulary  
  • RFL:
    • Non-formulary
  • RNOH:
    • Restricted to named Consultants within the Chronic Pain team (Dr Roxy Zarnegar and Dr Tacson Fernandez) ONLY in accordance with DTC approval
  • UCLH:
  • WH:
    • Non-formulary
 
10.03.02  Poultices to top
Kaolin Poultice
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
10.04  Unlicensed Medicines / Significant off-label use
Anakinra
(Gout)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for gout for patients who are hospitalised and refractory to all other treatments. The usual dose is 100 mg daily subcutaneously for 3 days (JFC September 2014) 

Provider notes

  • NMUH:
    • To be prescribed/ recommended by Rheumatology Consultants ONLY
    • Anakinra has been approved for gout. This is an unlicensed indication and the recommended dose is 100mg by subcutaneous injection ONCE a day for 3 days.
    • Check MHRA Drug Safety Updates
  • RFL:
    • Non-formulary
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY.
    • Unlicensed for the treatment of gout, 100mg daily for 3 days
  • UCLH:
  • WH:
    • Restricted to Rheumatology Consultants ONLY
 
Anakinra
(Haemophagocytic lymphohistiocytosis (HLH))
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for secondary haemophagocytic lymphohistiocytosis subject to individual funding approval (JFC September 2018). Additional information: Evidence to support SC or IV (local practice is to administer in 100mL sodium chloride 0.9%w/v over 1 hour). 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Prior funding required
    • Restricted to Rheumatology
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Thalidomide
(Rheumatology)
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Restricted Drug Restricted
GP - Red
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for use in Behcet's (rheumatology) - consultant initiation only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Benzbromarone
(Gout)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Rheumatology and Renal initiation only – hospital only prescribing
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
 ....
 Non Formulary Items
Diethylamine salicylate 10% w/w cream

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red
High Cost Medicine
Anakinra
(Rheumatoid arthritis)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red
High Cost Medicine

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
Ataluren granules

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine

See NICE HST for eligibility criteria

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
Link  NICE HST3: Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene
Auranofin (Ridaura®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Canakinumab
(Rheumatology)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Link  NICE TA281 (not recommended): Canakinumab for treating gouty arthritis attacks and reducing the frequency of subsequent attacks (terminated appraisal)
Link  NICE TA302 (not recommended): Canakinumab for treating systemic juvenile idiopathic arthritis (terminated appraisal)
Collagenase injection
(Dupuytren’s contracture)

View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Restricted: See monograph for Peyronie's disease.

This product has been withdrawn. 

Link  NICE TA459: Collagenase clostridium histolyticum for treating Dupuytren’s contracture
Dexibuprofen

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Diclofenac gel (Topical)
(Rheumatology)

View adult BNF View SPC online View childrens BNF
Non Formulary

Available as 1.16% and 2.32%

Diclofenac potassium

View adult BNF View SPC online View childrens BNF
Non Formulary
Fampridine
(Multiple sclerosis)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • UCLH approvals:
    • Improvement of walking in patients with multiple sclerosis. Restricted to presribing from Dr Rachel Farrells clinicl only in line with protocol - UMC July 2016
Fampridine
(Down-beat nystagmus)

View adult BNF View SPC online View childrens BNF
Non Formulary
GP - Red

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for treatment of down-beat nystagmus (November 2013). Query UCLH approved?

Fenoprofen

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Hyaluronic acid

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

Not approved for knee osteoarthritis (February 2013)

Hylan G-F 20 (Synvisc®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Ibuprofen 10% gel

View adult BNF View SPC online View childrens BNF
Non Formulary
Ibuprofen modified release

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Ketoprofen 2.5% gel

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NICE TA506 (not recommended): Lesinurad for treating chronic hyperuricaemia in people with gout
Movelat gel / cream

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Naproxen + Esomeprazole

View adult BNF View SPC online View childrens BNF
Non Formulary
Naproxen + Misoprostol

View adult BNF View SPC online View childrens BNF
Non Formulary
Nusinersen injection

View adult BNF View SPC online View childrens BNF
Non Formulary

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
Link  NICE TA588: Nusinersen for treating spinal muscular atrophy
Pegloticase (Krystexxa)

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  NICE TA291: Pegloticase not recommended for severe chronic gout
Sodium hyaluronate and triamcinolone hexacetonide
(Cingal)

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

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

View adult BNF View SPC online View childrens BNF
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
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
Homecare
Homecare

Traffic Light Status Information

Status Description

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.  

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

See link for the complete NCL Red List https://www.ncl-mon.nhs.uk/wp-content/uploads/2017/08/ncl_red_list.pdf

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

netFormulary