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
10.01.04  Expand sub section  Long-term control of gout
Allopurinol tabs
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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
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Link  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
Link  MHRA Jun 2012: Febuxostat (Adenuric): stop treatment if signs or symptoms of serious hypersensitivity
Link  NICE TA164: Hyperuricaemia - febuxostat
Benzbromarone tabs
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Unlicensed Drug 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
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Unlicensed Drug Unlicensed

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

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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)

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