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		  
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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  Expand sub section  Gout and cytotoxic-induced hyperuricaemia
10.01.04  Expand sub section  Acute attacks of gout
10.01.04  Expand sub section  Long-term control of gout
Allopurinol tabs
View adult BNF View SPC online 		Formulary
Green

Approved for all licensed indications

And the following off-label indication (Amber):

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 

 
Link  Crohn’s and Colitis UK: Azathioprine & Mercaptopurine
   
Febuxostat tabs
View adult BNF View SPC online 		Formulary  
Link  MHRA Jun 2012: Febuxostat (Adenuric): stop treatment if signs or symptoms of serious hypersensitivity
Link  NICE TA164: Hyperuricaemia - febuxostat
   
Benzbromarone tabs
View adult BNF View SPC online 		Unlicensed Drug Unlicensed
Red

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
View adult BNF View SPC online 		Unlicensed Drug Unlicensed

 
   
10.01.04  Expand sub section  Hyperuricaemia associated with cytotoxic drugs
 ....
 Non Formulary Items
Lesinurad tabs

View adult BNF View SPC online 		Non Formulary
Grey

Not approved for use in SE London for treating chronic hyperuricaemia in people with gout as per NICE Technology Appraisal guidance (see link below)
Link  NICE TA506: Lesinurad for treating chronic hyperuricaemia in people with gout
 
  
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
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 Link to adult BNF
click to search medicines.org.uk
 Link to SPCs
SMC
 Scottish Medicines Consortium
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

Red

 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  

Green

 Specialist and non-specialist initiation  

Grey

 Not recommended for prescribing  

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