netFormulary South East London Joint Medicines Formulary NHS
Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter

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.

10.01.04  Expand sub section  Gout and cytotoxic-induced hyperuricaemia
10.01.04  Expand sub section  Acute attacks of gout
Anakinra injection (cytokine release syndrome (CRS) or neurotoxicity after CAR-T therapy - off-label)
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Approved off-label indications:

  • Cytokine release syndrome (CRS) after CAR-T therapy where tocilizumab has failed.
  • Immune effector cell-associated neurotoxicity syndrome (ICANS) after CAR-T therapy where corticosteroids have failed.

Approved for KCH only, as patients with CRS should ideally be treated at their CAR-T therapy centre.

Dose: 200 mg s.c. every 24 hours. Continue for 24 hours after symptom resolution.

Colchicine tablets (licensed use)
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Anakinra injection (Polyarticular acute gout - off-label)
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Restricted Drug Restricted
High Cost Medicine

Approved off-label indication (consultant specialists only):

Polyarticular acute gout and multiple swollen joints where:

  • There have been recurrent acute flares of gout
  • There has been lack of response to, or contra-indications to NSAIDs, colchicine and steroids

Dose = 100mg daily for 3 days

See APC recommendation for further information

Link  SE London APC recommendation: anakinra for acute gout
10.01.04  Expand sub section  Long-term control of gout
10.01.04  Expand sub section  Hyperuricaemia associated with cytotoxic drugs
 Non Formulary Items
Canakinumab injection

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Non Formulary

Not approved for use in SE London.

See NICE TA281

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
Track Changes
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Link to adult BNF
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Link to SPCs
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHS England

Traffic Light Status Information

Status Description


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.   

Amber 1

Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

Amber 2

Specialist initiation followed by maintenance prescribing in primary care  

Amber 3

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  


Specialist and non-specialist initiation  


Not recommended for prescribing