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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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First Choice Ibuprofen is the PCT's first line choice.
Tablets 200mg and 400mg
Suspension 100mg/5ml

Low-dose ibuprofen (≤1200 mg/day) is an appropriate first choice NSAID in view of its low risk of GI and CV side effects.

Patients at high risk of GI events should be prescribed a formulary NSAID + a PPI (omeprazole or lansoprazole) 
Naproxen tablets 250mg
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Second Choice Naproxen is now the preferred NSAID choice over diclofenac.

Patients at high risk of GI events should be prescribed a formulary NSAID + a PPI (omeprazole or lansoprazole) 
   
Naproxen 50mg/ml oral suspension
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Restricted Drug Restricted Ordered on request for use in paediatrics or swallowing difficulties 
   
Diclofenac Sodium
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Formulary Suppositories 12.5mg, 25mg, 50mg and 100mg
Gel 1%
Injection 75mg/3ml 
   
Diclofenac Sodium
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Restricted Drug Restricted

E/C tablets 25mg and 50mg
M/R tablets 75mg and 100mg

 Use of oral diclofenac is restricted to the following situations:



  • In post caesarean section patients who are breast feeding and taking medication orally, ibuprofen is still first line choice for these patients, however diclofenac (short term and at the lowest possible dose) is second line as it is safer in breast feeding than naproxen


 



  • In the absence of contraindications, patients with renal colic or renal stones may be treated with a short course of oral diclofenac


 



  • For paediatric patients who require short term oral NSAIDs, ibuprofen is first line, diclofenac will be second line (as this has more indications than naproxen in children)


 



  • Chronic long term users of diclofenac (e.g. rheumatology patients, palliative care patients) must be reviewed on an individual patient basis and a decision made accordingly

 
   
Diclofenac Sodium 75mg/1ml injection (Akis®)
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Formulary  
   
Etodolac 300mg capsules
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Formulary Ordered on demand 
   
Etodolac 600mg MR capsules (Lodine SR®)
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Formulary  
   
Etoricoxib tablets
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Formulary

30mg, 60mg, 90mg and 120mg tablets

 
   
Indometacin
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Formulary Capsules 25mg
M/R capsules 75mg
Suppositories 100mg 
   
Mefenamic Acid
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Formulary Capsules 250mg
Tablets 500mg 
   
Meloxicam
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Formulary Tablets 7.5mg 
   
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 (Hydrocortistab®)
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Formulary Injection 25mg/ml 
   
Methylprednisolone Acetate (Depo-Medrone®)
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Formulary Injection 40mg/ml 
   
Triamcinolone Acetonide (Adcortyl®)
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Formulary Injection 10mg/ml 
   
Triamcinolone Acetonide (Kenalog®)
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Formulary Injection 40mg/ml 
   
10.01.03  Drugs which suppress the rheumatic disease process
Golimumab Injection 50mg (Simponi®)
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Restricted Drug Restricted  
Link  NICE TA220: Psoriatic arthritis - golimumab
Link  NICE TA225: Rheumatoid arthritis (after the failure of previous anti-rheumatic drugs) - golimumab
Link  NICE TA329: Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262)
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
   
Guselkumab solution for injection 100mg (Tremfya®)
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Formulary
High Cost Medicine
CCG

Pre-filled syringes

 
Link  NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
   
Tofacitinib tablets 5mg (Xeljanz®)
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Restricted Drug Restricted
Red
High Cost Medicine
 
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  NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
   
10.01.03  Gold to top
Auranofin (Ridaura®)
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Formulary Tablets 3mg 
   
Sodium Aurothomalate (Myocrisin®)
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Formulary Injection 10mg/0.5ml and 50mg/0.5ml 
   
10.01.03  Penicillamine
Penicillamine
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Formulary
Amber 1
Tablets 125mg and 250mg 
   
10.01.03  Antimalarials
Chloroquine Phosphate
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Formulary Tablets 250mg (base 155mg) 
   
Hydroxychloroquine Sulphate (Plaquenil®)
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Formulary
Amber 1
Tablets 200mg 
   
10.01.03  Drugs affecting the immune response
Abatacept (Orencia®)
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Restricted Drug Restricted
Red
 
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA280: Rheumatoid arthritis - abatacept (2nd line)
   
Adalimumab (Humira®)
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Restricted Drug Restricted
Red
Injection 40mg/0.8ml 
Link  NICE TA130: Rheumatoid arthritis - adalimumab, etanercept and infliximab
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Anakinra (Kineret®)
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Restricted Drug Restricted Injection 100mg/0.67ml 
   
Azathioprine
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Formulary
Amber 1
Tablets 25mg and 50mg 
   
Baricitinib tablets (Olumiant®)
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Restricted Drug Restricted
Red
High Cost Medicine
-2mg and 4mg tablets 
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
   
Brodalumab 210mg/1.5ml solution for injection pre-filled syringes  (Kyntheum®)
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Formulary
Red
High Cost Medicine
CCG
 
Link  NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
   
Certolizumab Pegol Injection 200mg (Cimzia®)
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Restricted Drug Restricted
Red
 
Link  NICE TA186: Rheumatoid arthritis - certolizumab pegol
Link  NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
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 DMARDs
   
Ciclosporin
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Formulary
Amber 1
Capsules 25mg, 50mg and 100mg
Oral solution 100mg/ml
Concentrate for infusion 50mg/ml 
   
Dupilumab (Dupixent®)
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Formulary  
Link  NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
   
Etanercept (Enbrel®)
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Formulary
Red
Injection 50mg 
Link  NICE TA130: Rheumatoid arthritis - adalimumab, etanercept and infliximab
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Infliximab (Remicade®)
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Formulary
Amber 1
Infusion 100mg 
Link  NICE TA130: Rheumatoid arthritis - adalimumab, etanercept and infliximab
Link  NICE TA134: Psoriasis - infliximab
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Leflunomide (Arava®)
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Formulary
Amber 1
Tablets 10mg, 20mg and 100mg 
   
Methotrexate (Metoject®)
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Formulary
Red
Pre-filled pens: 7.5mg, 10mg, 12.5mg, 15mg, 17.5mg, 20mg, 22.5mg and 25mg 
   
Cytotoxic Drug Methotrexate tablets 2.5mg
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Formulary
Amber 1
For rheumatology indications and myasthenia gravis. For other indications, see relevant chapters.
 
   
Risankizumab (Skyrizi®)
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Restricted Drug Restricted  
Link  NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
   
Rituximab (MabThera®)
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Restricted Drug Restricted
Red
 
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA308: Vasculitis (anti-neutrophil cytoplasmic antibody-associated) - rituximab (with glucocorticoids)
   
Tocilizumab (RoActemra®)
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Formulary
Red
Infusion 80mg/4ml 
Link  NICE TA238: Arthritis (juvenile idiopathic, systemic) - tocilizumab
Link  NICE TA247: Rheumatoid arthritis - tocilizumab
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
   
10.01.03  Cytokine modulators
10.01.03  Sulfasalazine to top
Sulfasalazine
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Formulary Tablets 500mg 
   
Sulfasalazine (Salazopyrin EN-Tabs®)
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Formulary E/C tablets 500mg 
   
10.01.04  Gout and cytotoxic-induced hyperuricaemia
10.01.04  Acute attacks of gout
Colchicine
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Formulary Tablets 500mcg 
   
10.01.04  Long-term control of gout
Allopurinol
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Formulary Tablets 100mg and 300mg 
   
Febuxostat (Adenuric®)
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Formulary Tablets 80mg 
   
Sulfinpyrazone (Anturan®)
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Formulary Tablets 100mg 
   
10.01.04  Hyperuricaemia associated with cytotoxic drugs
Rasburicase (Fastertec®)
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Restricted Drug Restricted The use of Rasburicase is restricted to Haematology only.

Injection 7.5mg 
   
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
Edrophonium Chloride
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Restricted Drug Restricted CURRENTLY UNAVAILABLE (UNLICENSED PREPARATION PENDING)
Injection 10mg/ml 
   
Neostigmine
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Formulary Tablets 15mg
Injection 2.5mg/ml 
   
Pyridostigmine Bromide (Mestinon®)
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Formulary Tablets 60mg 
   
10.02.01  Immunosuppressant therapy
10.02.02  Skeletal muscle relaxants to top
Baclofen
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Formulary Tablets 10mg
Sugar free Liquid 5mg/5ml 
   
Dantrolene Sodium (Dantrium®)
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Formulary Capsules 25mg 
   
Diazepam
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Formulary Tablets 2mg and 5mg
Oral solution 2mg/5ml and 5mg/5ml
Injection (emulsion) 10mg/2ml
Injection (solution) 10mg/2ml
Rectal tubes 2.5mg, 5mg, and 10mg 
   
Tizanidine
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Formulary Tablets 2mg and 4mg 
   
10.02.02  Other muscle relaxants
10.02.02  Nocturnal leg cramps
Quinine sulphate
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Formulary Tablets 300mg 
   
10.03  Drugs for the relief of soft-tissue inflammation and topical pain relief
10.03  Extravasation
10.03.01  Enzymes to top
Hyaluronidase (Hyalase®)
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Formulary Injection 1500 units 
   
10.03.02  Rubefacients, topical NSAIDs, capsaicin, and poultices
10.03.02  Topical NSAIDs and counter-irritants
Ibuprofen gel 5% (50g)
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Formulary  
   
Diclofenac (Voltarol Emulgel®)
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Formulary 1% Gel 
   
Piroxicam
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Formulary Topical Piroxicam is on the PCT's formulary.

0.5% Gel 
   
Diethylamine salicylate cream 10%w/w (Algesal)
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Formulary  
   
10.03.02  Capsaicin
Capsaicin patch (Qutenza®)
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Restricted Drug Restricted
Red
Chronic Pain Consultants only 
   
10.03.02  Poultices
 ....
 Non Formulary Items
Acelofenac  (Preservex®)

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Non Formulary
 
Acemetacin  (Emflex®)

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Non Formulary
 
Allopurinol  (Zyloric®)

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Non Formulary
 
Axsain®

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Non Formulary
 
Azapropazone  (Rheumox®)

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Non Formulary
 
Baclofen  (Lioresal®)

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Non Formulary
 
Belimumab Infusion  (Benlysta®)

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Non Formulary 120mg and 400mg Vial
Link  NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
 
Benzydamine Hydrochloride

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Non Formulary
 
Betamethasone  (Betnesol®)

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Non Formulary
 
Cannabis Extract  (Sativex®)

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Non Formulary
RedRed
 
Capsaicin  (Zacin®)

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Non Formulary
 
Carisoprodol  (Carisoma®)

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Non Formulary
 
Celecoxib  (Celebrex®)

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Non Formulary
 
Collagenase Clostridium histolyticum 900microgram Injection  (Xiapex®)

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Non Formulary
Link  NICE TA459: Collagenase clostridium histolyticum for treating Dupuytren’s contracture
 
Dexamethasone

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Non Formulary
 
Dexamethasone Phosphate

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Non Formulary
 
Dexibuprofen  (Seractil®)

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Non Formulary
 
Dexketoprofen  (Keral®)

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Non Formulary
 
Diclofenac Sodium  (Diclomax Retard®)

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Non Formulary
 
Diclofenac Sodium  (Diclomax SR®)

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Non Formulary
 
Diclofenac Sodium  (Dyloject®)

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Non Formulary
 
Diclofenac Sodium  (Mobigel®)

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Non Formulary
 
Diclofenac Sodium  (Motifene® 75mg)

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Non Formulary
 
Diclofenac Sodium  (Voltarol®)

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Non Formulary
 
Diclofenac Sodium  (Voltarol® 75 mg SR)

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Non Formulary
 
Diclofenac Sodium  (Voltarol® Radid)

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Non Formulary
 
Diclofenac Sodium  (Voltarol® Retard)

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Non Formulary
 
Diclofenac Sodium with Misoprostol  (Arthrotec 50 and 75®)

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Non Formulary
 
Distigmine Bromide

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Non Formulary
 
Fampridine 10 mg MR Tablet  (Fampyra®)

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Non Formulary
RedRed
 
Felbinac  (Traxam®)

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Non Formulary 3% gel
 
Feldene®

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Non Formulary
 
Fenbid® Forte Gel

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Non Formulary
 
Fenoprofen  (Fenopron®)

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Non Formulary
 
Flurbiprofen

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Non Formulary
 
Flurbiprofen  (Froben®)

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Non Formulary
 
Glucosamine

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Non Formulary
RedRed
 
Glucosamine 1.5g Tablet  (Dolenio®)

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Non Formulary
 
Hyaluronic acid  (Hyalgan®)

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Non Formulary
 
Hylan G-F 20  (Synvisc®)

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Non Formulary
 
Ibugel® Forte

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Non Formulary Gel 10%
 
Ibuprofen  (Brufen Retard®)

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Non Formulary
 
Ibuprofen  (Brufen®)

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Non Formulary
 
Ibuprofen  (Fenbid®)

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Non Formulary
 
Indometacin  (Indometacin MR)

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Non Formulary
 
Kaolin Poultice

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Non Formulary
 
Kaolin Poultice  (Kaolin Poultice K/L Pack®)

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Non Formulary
 
Ketoprofen

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Non Formulary
 
Ketoprofen  (Orudis®)

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Non Formulary
 
Ketoprofen  (Oruvail®)

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Non Formulary
 
Ketoprofen  (Oruvail® MR)

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Non Formulary
 
Ketoprofen with omeprazole  (Axorid®)

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Non Formulary
RedRed
 
Lumiracoxib  (Prexige®)

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Non Formulary
 
Mefenamic Acid  (Ponstan®)

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Non Formulary
 
Methocarbamol  (Robaxin®)

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Non Formulary
 
Methotrexate Pre-Filled Injection  (Ebetrex®)

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Non Formulary
 
Methylprednisolone Acetate  (Depo-Medrone® with Lidocaine)

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Non Formulary
 
Nabumetone

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Non Formulary
 
Nabumetone  (Relifex®)

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Non Formulary
 
Naproxen  (Naprosyn®)

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Non Formulary
 
Naproxen and esomeprazole  (Vimovo ®)

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Non Formulary
RedRed
 
Naproxen with Misoprostol  (Napratec®)

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Non Formulary
 
Oruvail®

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Non Formulary
 
Pegloticase

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Non Formulary
Link  NICE TA291: Gout (tophaceous, severe debilitating, chronic) - pegloticase
 
Penicillamine  (Distamine®)

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Non Formulary
Amber 1
 
Pennsaid®

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Non Formulary
 
Piroxicam

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Non Formulary
 
Piroxicam  (Brexidol®)

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Non Formulary
 
Piroxicam  (Feldene®)

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Non Formulary
 
Powergel®

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Non Formulary
 
Prednisolone Acetate  (Deltastab®)

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Non Formulary
 
Sulindac

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Non Formulary
 
Sulindac  (Clinoril®)

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Non Formulary
 
Tenoxicam  (Mobiflex®)

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Non Formulary
 
Tiaprofenic Acid

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Non Formulary
 
Tiaprofenic Acid  (Surgam®)

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Non Formulary
 
Tizanidine  (Zanaflex®)

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Non Formulary
 
Triamcinolone Acetonide  (Adcorty'®)

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Non Formulary
 
Voltarol Gel Patch®

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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
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

Amber 1

"Amber 1" - These are medicines that require significant monitoring and the decision to treat with an AMBER medicine should be made by specialists only  

Amber 2

"Amber 2" - These are medicines that require little or no monitoring by the GP, but should only be prescribed in general practice after they have been recommended following specialist referral.  

Red

"Red" - Secondary care only  

RedRed

"Double Red" - NOT recommended for prescribing in either primary or secondary care  

Grey

Traffic light status to be confirmed  

Green

May be prescribed in primary and secondary care  

netFormulary