South East London Joint Medicines Formulary Formulary

	South East London Joint Medicines Formulary
	Guy's and St Thomas' NHS Foundation Trust Kings College Hospital NHS Foundation Trust Lewisham and Greenwich NHS Trust

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Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter

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.

Details...

10.01.04

Gout and cytotoxic-induced hyperuricaemia

10.01.04

Acute attacks of gout

10.01.04

Long-term control of gout

Allopurinol tabs

Formulary

Approved for all licensed indications

And the following off-label indication ():

In combination with thiopurines (i.e. azathioprine or mercaptopurine) in the treatment of Crohn’s Disease or Ulcerative Colitis where the patient has shown:

Hypermethylation of thiopurine (MeMP: TGN ratio >11:1)
Abnormal LFTs secondary to standard thiopurine treatment
Other non-myelotoxic side-effects, excluding pancreatitis, on standard thiopurines, which limit dose optimization
Dose = Allopurinol 100mg daily
Dose reduction of the thiopurine to approximately 25% of the usual target dose is required to avoid dose-related toxicity.
See information leaflet (link below) for further information

Crohn’s and Colitis UK: Azathioprine & Mercaptopurine

Febuxostat tabs

Formulary

MHRA Jul 2019: Febuxostat (Adenuric): increased risk of cardiovascular death and all-cause mortality in clinical trial in patients with a history of major cardiovascular disease

MHRA Jun 2012: Febuxostat (Adenuric): stop treatment if signs or symptoms of serious hypersensitivity

NICE TA164: Hyperuricaemia - febuxostat

Benzbromarone tabs

Unlicensed

Approved for use in the treatment of gout for patients resistant to, or intolerant of, xanthine oxidase inhibitors (off-label)

Dose = 50 mg to 200 mg per day

Sulfinpyrazone tabs

Unlicensed

10.01.04

Hyperuricaemia associated with cytotoxic drugs

....

Non Formulary Items

Lesinurad tabs

Non Formulary

Not approved for use in SE London for treating chronic hyperuricaemia in people with gout as per NICE Technology Appraisal guidance (see link below)

NICE TA506: Lesinurad for treating chronic hyperuricaemia in people with gout

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

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.
	Treatment can be initiated in primary care after a recommendation from an appropriate specialist
	Specialist initiation followed by maintenance prescribing in primary care
	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