| Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
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| 10.01 |
Drugs used in rheumatic diseases and gout |
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| 10.01 |
Rheumatoid arthritis and other inflammatory disorders |
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| 10.01 |
Osteoarthritis and soft-tissue disorders |
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| 10.01.01 |
Non-steroidal anti-inflammatory drugs |
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Ibuprofen
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First Choice
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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)
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Naproxen tablets 250mg
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Second Choice
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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)
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Naproxen 50mg/ml oral suspension
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 Restricted
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Ordered on request for use in paediatrics or swallowing difficulties
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Diclofenac Sodium
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Formulary
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Suppositories 12.5mg, 25mg, 50mg and 100mg
Gel 1%
Injection 75mg/3ml
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Diclofenac Sodium
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Restricted
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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
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Diclofenac Sodium 75mg/1ml injection (Akis®)
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Formulary
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Etodolac 300mg capsules
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Formulary
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Ordered on demand
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Etodolac 600mg MR capsules (Lodine SR®)
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Formulary
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Etoricoxib tablets
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Formulary
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30mg, 60mg, 90mg and 120mg tablets
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Indometacin
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Formulary
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Capsules 25mg
M/R capsules 75mg
Suppositories 100mg
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Mefenamic Acid
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Formulary
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Capsules 250mg
Tablets 500mg
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Meloxicam
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Formulary
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Tablets 7.5mg
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| 10.01.01 |
Aspirin |
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| 10.01.02.01 |
Systemic corticosteroids |
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| 10.01.02.02 |
Local corticosteroids injections |
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Hydrocortisone acetate (Hydrocortistab®)
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Formulary
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Injection 25mg/ml
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Methylprednisolone Acetate (Depo-Medrone®)
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Formulary
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Injection 40mg/ml
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Triamcinolone Acetonide (Adcortyl®)
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Formulary
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Injection 10mg/ml
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Triamcinolone Acetonide (Kenalog®)
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Formulary
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Injection 40mg/ml
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| 10.01.03 |
Drugs which suppress the rheumatic disease process |
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Golimumab Injection 50mg (Simponi®)
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Restricted
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 NICE TA220: Psoriatic arthritis - golimumab
NICE TA225: Rheumatoid arthritis (after the failure of previous anti-rheumatic drugs) - golimumab
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)
NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
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Guselkumab solution for injection 100mg (Tremfya®)
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Formulary
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Pre-filled syringes
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NICE TA521: Guselkumab for treating moderate to severe plaque psoriasis
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Tofacitinib tablets 5mg (Xeljanz®)
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Restricted
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NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
NICE TA543: Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
NICE TA547: Tofacitinib for moderately to severely active ulcerative colitis
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| 10.01.03 |
Gold |
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Auranofin (Ridaura®)
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Formulary
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Tablets 3mg
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Sodium Aurothomalate (Myocrisin®)
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Formulary
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Injection 10mg/0.5ml and 50mg/0.5ml
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Penicillamine
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Formulary
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Tablets 125mg and 250mg
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Chloroquine Phosphate
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Formulary
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Tablets 250mg (base 155mg)
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Hydroxychloroquine Sulphate (Plaquenil®)
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Formulary
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Tablets 200mg
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| 10.01.03 |
Drugs affecting the immune response |
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Abatacept (Orencia®)
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Restricted
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NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
NICE TA280: Rheumatoid arthritis - abatacept (2nd line)
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Adalimumab (Humira®)
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Restricted
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Injection 40mg/0.8ml
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NICE TA130: Rheumatoid arthritis - adalimumab, etanercept and infliximab
NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
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Anakinra (Kineret®)
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Restricted
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Injection 100mg/0.67ml
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Azathioprine
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Formulary
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Tablets 25mg and 50mg
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Baricitinib tablets (Olumiant®)
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Restricted
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-2mg and 4mg tablets
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NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
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Brodalumab 210mg/1.5ml solution for injection pre-filled syringes (Kyntheum®)
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Formulary
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NICE TA511: Brodalumab for treating moderate to severe plaque psoriasis
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Certolizumab Pegol Injection 200mg (Cimzia®)
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Restricted
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NICE TA186: Rheumatoid arthritis - certolizumab pegol
NICE TA574: Certolizumab pegol for treating moderate to severe plaque psoriasis
NICE: TA383 TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
NICE TA415:Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
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Ciclosporin
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Formulary
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Capsules 25mg, 50mg and 100mg
Oral solution 100mg/ml
Concentrate for infusion 50mg/ml
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Dupilumab (Dupixent®)
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Formulary
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NICE TA534: Dupilumab for treating moderate to severe atopic dermatitis
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Etanercept (Enbrel®)
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Formulary
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Injection 50mg
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NICE TA130: Rheumatoid arthritis - adalimumab, etanercept and infliximab
NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
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Infliximab (Remicade®)
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Formulary
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Infusion 100mg
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NICE TA130: Rheumatoid arthritis - adalimumab, etanercept and infliximab
NICE TA134: Psoriasis - infliximab
NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
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Leflunomide (Arava®)
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Formulary
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Tablets 10mg, 20mg and 100mg
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Methotrexate (Metoject®)
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Formulary
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Pre-filled pens: 7.5mg, 10mg, 12.5mg, 15mg, 17.5mg, 20mg, 22.5mg and 25mg
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Methotrexate tablets 2.5mg
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Formulary
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For rheumatology indications and myasthenia gravis. For other indications, see relevant chapters.
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Risankizumab (Skyrizi®)
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Restricted
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NICE TA596: Risankizumab for treating moderate to severe plaque psoriasis
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Rituximab (MabThera®)
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Restricted
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NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
NICE TA308: Vasculitis (anti-neutrophil cytoplasmic antibody-associated) - rituximab (with glucocorticoids)
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Tocilizumab (RoActemra®)
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Formulary
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Infusion 80mg/4ml
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NICE TA238: Arthritis (juvenile idiopathic, systemic) - tocilizumab
NICE TA247: Rheumatoid arthritis - tocilizumab
NICE TA518: Tocilizumab for treating giant cell arteritis
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| 10.01.03 |
Cytokine modulators |
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| 10.01.03 |
Sulfasalazine |
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Sulfasalazine
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Formulary
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Tablets 500mg
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Sulfasalazine (Salazopyrin EN-Tabs®)
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Formulary
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E/C tablets 500mg
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| 10.01.04 |
Gout and cytotoxic-induced hyperuricaemia |
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| 10.01.04 |
Acute attacks of gout |
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Colchicine
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Formulary
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Tablets 500mcg
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| 10.01.04 |
Long-term control of gout |
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Allopurinol
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Formulary
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Tablets 100mg and 300mg
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Febuxostat (Adenuric®)
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Formulary
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Tablets 80mg
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Sulfinpyrazone (Anturan®)
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Formulary
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Tablets 100mg
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| 10.01.04 |
Hyperuricaemia associated with cytotoxic drugs |
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Rasburicase (Fastertec®)
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Restricted
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The use of Rasburicase is restricted to Haematology only.
Injection 7.5mg
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| 10.01.05 |
Other drugs for rheumatic diseases |
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| 10.02 |
Drugs used in neuromuscular disorders |
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| 10.02.01 |
Drugs which enhance neuromuscular transmission |
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| 10.02.01 |
Anticholinesterases |
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Edrophonium Chloride
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Restricted
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CURRENTLY UNAVAILABLE (UNLICENSED PREPARATION PENDING)
Injection 10mg/ml
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Neostigmine
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Formulary
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Tablets 15mg
Injection 2.5mg/ml
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Pyridostigmine Bromide (Mestinon®)
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Formulary
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Tablets 60mg
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| 10.02.01 |
Immunosuppressant therapy |
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| 10.02.02 |
Skeletal muscle relaxants |
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Baclofen
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Formulary
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Tablets 10mg
Sugar free Liquid 5mg/5ml
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Dantrolene Sodium (Dantrium®)
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Formulary
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Capsules 25mg
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Diazepam
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Formulary
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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
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Tizanidine
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Formulary
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Tablets 2mg and 4mg
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| 10.02.02 |
Other muscle relaxants |
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| 10.02.02 |
Nocturnal leg cramps |
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Quinine sulphate
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Formulary
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Tablets 300mg
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| 10.03 |
Drugs for the relief of soft-tissue inflammation and topical pain relief |
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| 10.03.01 |
Enzymes |
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Hyaluronidase (Hyalase®)
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Formulary
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Injection 1500 units
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| 10.03.02 |
Rubefacients, topical NSAIDs, capsaicin, and poultices |
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| 10.03.02 |
Topical NSAIDs and counter-irritants |
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Ibuprofen gel 5% (50g)
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Formulary
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Diclofenac (Voltarol Emulgel®)
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Formulary
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1% Gel
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Piroxicam
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Formulary
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Topical Piroxicam is on the PCT's formulary.
0.5% Gel
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Diethylamine salicylate cream 10%w/w (Algesal)
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Formulary
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Capsaicin patch (Qutenza®)
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Restricted
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Chronic Pain Consultants only
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| .... |
| Non Formulary Items |
Acelofenac (Preservex®)
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Non Formulary
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Acemetacin (Emflex®)
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Non Formulary
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Allopurinol (Zyloric®)
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Non Formulary
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Axsain®
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Non Formulary
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Azapropazone (Rheumox®)
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Non Formulary
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Baclofen (Lioresal®)
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Non Formulary
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Belimumab Infusion (Benlysta®)
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Non Formulary
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120mg and 400mg Vial |
NICE TA397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
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Benzydamine Hydrochloride
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Non Formulary
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Betamethasone (Betnesol®)
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Non Formulary
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Cannabis Extract (Sativex®)
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Non Formulary
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Capsaicin (Zacin®)
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Non Formulary
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Carisoprodol (Carisoma®)
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Non Formulary
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Celecoxib (Celebrex®)
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Non Formulary
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Collagenase Clostridium histolyticum 900microgram Injection (Xiapex®)
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Non Formulary
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NICE TA459: Collagenase clostridium histolyticum for treating Dupuytren’s contracture
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Dexamethasone
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Non Formulary
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Dexamethasone Phosphate
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Non Formulary
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Dexibuprofen (Seractil®)
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Non Formulary
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Dexketoprofen (Keral®)
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Non Formulary
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Diclofenac Sodium (Diclomax Retard®)
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Non Formulary
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Diclofenac Sodium (Diclomax SR®)
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Non Formulary
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Diclofenac Sodium (Dyloject®)
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Non Formulary
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Diclofenac Sodium (Mobigel®)
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Non Formulary
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Diclofenac Sodium (Motifene® 75mg)
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Non Formulary
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Diclofenac Sodium (Voltarol®)
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Non Formulary
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Diclofenac Sodium (Voltarol® 75 mg SR)
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Non Formulary
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Diclofenac Sodium (Voltarol® Radid)
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Non Formulary
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Diclofenac Sodium (Voltarol® Retard)
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Non Formulary
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Diclofenac Sodium with Misoprostol (Arthrotec 50 and 75®)
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Non Formulary
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Distigmine Bromide
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Non Formulary
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Fampridine 10 mg MR Tablet (Fampyra®)
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Non Formulary
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Felbinac (Traxam®)
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Non Formulary
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3% gel |
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Feldene®
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Non Formulary
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Fenbid® Forte Gel
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Non Formulary
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Fenoprofen (Fenopron®)
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Non Formulary
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Flurbiprofen
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Non Formulary
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Flurbiprofen (Froben®)
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Non Formulary
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Glucosamine
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Non Formulary
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Glucosamine 1.5g Tablet (Dolenio®)
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Non Formulary
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Hyaluronic acid (Hyalgan®)
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Non Formulary
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Hylan G-F 20 (Synvisc®)
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Non Formulary
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Ibugel® Forte
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Non Formulary
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Gel 10% |
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Ibuprofen (Brufen Retard®)
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Non Formulary
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Ibuprofen (Brufen®)
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Non Formulary
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Ibuprofen (Fenbid®)
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Non Formulary
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Indometacin (Indometacin MR)
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Non Formulary
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Kaolin Poultice
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Non Formulary
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Kaolin Poultice (Kaolin Poultice K/L Pack®)
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Non Formulary
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Ketoprofen
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Non Formulary
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Ketoprofen (Orudis®)
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Non Formulary
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Ketoprofen (Oruvail®)
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Non Formulary
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Ketoprofen (Oruvail® MR)
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Non Formulary
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Ketoprofen with omeprazole (Axorid®)
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Non Formulary
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Lumiracoxib (Prexige®)
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Non Formulary
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Mefenamic Acid (Ponstan®)
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Non Formulary
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Methocarbamol (Robaxin®)
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Non Formulary
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Methotrexate Pre-Filled Injection (Ebetrex®)
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Non Formulary
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Methylprednisolone Acetate (Depo-Medrone® with Lidocaine)
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Non Formulary
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Nabumetone
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Non Formulary
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Nabumetone (Relifex®)
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Non Formulary
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Naproxen (Naprosyn®)
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Non Formulary
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Naproxen and esomeprazole (Vimovo ®)
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Non Formulary
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Naproxen with Misoprostol (Napratec®)
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Non Formulary
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Oruvail®
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Non Formulary
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Pegloticase
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Non Formulary
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NICE TA291: Gout (tophaceous, severe debilitating, chronic) - pegloticase
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Penicillamine (Distamine®)
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Non Formulary
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Pennsaid®
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Non Formulary
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Piroxicam
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Non Formulary
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Piroxicam (Brexidol®)
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Non Formulary
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Piroxicam (Feldene®)
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Non Formulary
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Powergel®
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Non Formulary
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Prednisolone Acetate (Deltastab®)
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Non Formulary
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Sulindac
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Non Formulary
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Sulindac (Clinoril®)
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Non Formulary
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Tenoxicam (Mobiflex®)
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Non Formulary
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Tiaprofenic Acid
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Non Formulary
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Tiaprofenic Acid (Surgam®)
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Non Formulary
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Tizanidine (Zanaflex®)
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Non Formulary
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Triamcinolone Acetonide (Adcorty'®)
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Non Formulary
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Voltarol Gel Patch®
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
| Status |
Description |
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"Amber 1" - These are medicines that require significant monitoring and the decision to treat with an AMBER medicine should be made by specialists only |
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"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. |
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"Red" - Secondary care only |
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"Double Red" - NOT recommended for prescribing in either primary or secondary care |
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Traffic light status to be confirmed |
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May be prescribed in primary and secondary care |
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