| Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
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| Notes: |
Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.
Formulary approved "off-label" use is detailed separately. |
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| Details... |
| 10.01.01 |
Non-steroidal anti-inflammatory drugs |
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Acelofenac tabs
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Formulary
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Arthrotec® tabs (diclofenac + misoprostol)
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Formulary
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Aspirin tabs (analgesia)
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Formulary
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Aspirin tabs (pericarditis - off-label)
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Formulary
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Approved off-label indication:
Acute pericarditis
Usual dose = 750 mg to 1 g three times a day for 1-2 weeks in first episode. Longer courses may be required for recurrent episodes.
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Celecoxib capsules
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Formulary
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Diclofenac sodium e/c, m/r & disp tabs, suppositories
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Formulary
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Approved for all licensed indications, and the following off-label indication:
Stat rectal dose prior to ERCP for prevention of post-ERCP pancreatitis
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 MHRA Jun 2013: Diclofenac: new contraindications and warnings
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Etoricoxib tabs
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Formulary
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Approved for:
Rheumatoid arthritis and ankylosing spondylitis
Restricted to use after a non-selective NSAID (e.g. naproxen), has failed to achieve symptom relief.
Refer to APC recommentation for further information (link below)
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 SE London APC recommendation: Etoricoxib 60mg and 90mg tablets for the symptomatic relief of symptoms in adults with ankylosing spondylitis and rheumatoid arthritis
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Fenbufen tabs
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Formulary
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Flurbiprofen tabs
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Formulary
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Ibuprofen tabs (pericarditis - off-label)
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Formulary
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Approved off-label indication:
Pericarditis
Usual dose = 600 mg three times a day for 1-2 weeks. Longer courses may be required for recurrence.
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Indometacin caps, m/r caps, suppositories (licensed use)
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Formulary
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Ketoprofen caps
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Formulary
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Mefenamic acid caps, tabs
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Formulary
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In secondary care use on gynaecology advice only for:
dysmenorrhoea
Menorrhagia
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Meloxicam tabs
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Formulary
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Nabumetone tabs, suspension
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 Restricted
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For palliative care patients with pain relating to soft tissue, visceral or bone inflammation
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Naproxen tabs
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Formulary
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Sulindac tabs
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Formulary
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Indometacin suppositories (prophylaxis of pancreatitis post ERCP)
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Formulary
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Approved off label indication:
- Stat rectal dose prior to ERCP for prevention of post-ERCP pancreatitis
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Phenylbutazone tablets
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 Unlicensed
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 Restricted use
Ankylosing spondylitis
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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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Specialist or hospital prescribing only.
The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital.
In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |
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Specialist initiation followed by maintenance prescribing in primary care |
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Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation |
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Specialist and non-specialist initiation |
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Not recommended for prescribing |
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