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Joint Formulary
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.04  Expand sub section  Unlicensed Medicines / Significant off-label use
Anakinra
(Gout)
View adult BNF View SPC online View childrens BNF
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 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))
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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 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)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
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

  • 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
 
   
 ....
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
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

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.

  

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