• 250mg and 500mg tablets
• Oral suspension and effervescent tablets available 
• No evidence for GI benefit of EC preparation - use standard tablets.

• - Salisbury & Swindon.
• - RUH - Oral diclofenac is only included on the formulary for maternity services for a short course of inpatient treatment post delivery.
• 25mg & 50mg gastro-resistant tablets
• Cardiovascular risk is higher with diclofenac than other non-selective NSAIDs and similar to selective COX-2 inhibitors.
• Oral diclofenac should be used for short courses only

• 12.5mg, 25mg, 50mg and 100mg suppositories
• 75mg in 3ml injection
• Cardiovascular risk is higher with diclofenac than other non-selective NSAIDs and similar to selective COX-2 inhibitors.
• Diclofenac should be used for short courses only.

•  GWH ONLY - For the short-term prevention & treatment of post - operative pain.
• Non- formulary at RUH and SFT
• 75mg in 1ml injection.
• Cardiovascular risk is higher with diclofenac than other non-selective NSAIDs and similar to selective COX-2 inhibitors.
• Diclofenac should be used for short courses only.

• Salisbury only
• Non formulary in BaNES and Swindon
• 100mg and 200mg capsules

• Salisbury only
• Non formulary in BaNES and Swindon
• 300mg capsules
• 600mg tablets and 600mg MR tablets

• - BaNES - Second line for treament of Ankylosing Spondylitis ONLY.
• - Swindon - Reserved for severe inflammatory arthritis unresponsive or intolerant to other NSAIDS.
•   - GWH ONLY - For the short-term prevention & treatment of post-operative pain in patients with known hypersensitivity to conventional NSAIDs, or patients at high risk of hypersenstivitiy to conventional NSAIDs (e.g. asthmatics).
• Non formulary - Salisbury.
• 30mg, 60mg, 90mg and 120mg tablets.

• BaNES and Swindon only
• Non formulary in Salisbury
• 25mg and 50mg
• 100mg suppositories

• 500mg tablets
• 250mg capsules

• - Swindon - Second-line after conventionals NSAIDs.
• - BaNES and Salisbury.
• - GWH ONLY - For the short-term prevention and treatment of post-operative pain in patients at high risk of bleeding with conventional NSAIDs (e.g. adult tonsillectomy, colorectal surgery, etc).
• 7.5mg and 15mg tablets. 

• RUH and GWH - Restricted for prescribing by Consultant Rheumatologist for named patients with ankylosing spondylitis.
• SFT - Restricted for prescribing by Consultant Rheumatologist for named patients with ankylosing spondylitis stabilised on therapy. No new patients.

• 25mg/1ml injection

• Titration pack, tablets, f/c, 14-day starter pack of apremilast 4 x 10 mg (pink) with 4 x 20 mg (brown) and 19 x 30 mg (beige).  
• Tablet, f/c, apremilast 30 mg (beige) for maintenance treatment.

• 2mg and 4mg tablets
• CCG commissioned as per NICE TA466

• 5mg and 10mg tablets
• CCG commissioned as per NICE TA543 and TA480

•   - BaNES, Salisbury & Swindon (except Swindon patients monitored via the DAWN system and provided with prescriptions by GWH)
•   - Swindon DAWN patients
• 125mg and 250mg tablets
• Please refer to our DMARD Shared Care and Monitoring Guidance for your respective locality for further information

• 200mg tablets
  
  
•   - BaNES, Salisbury & Swindon (except Swindon patients monitored via the DAWN system and provided with prescriptions by GWH)
•   - Swindon DAWN patients
• Please refer to our DMARD Shared Care and Monitoring Guidance for your respective locality for further information

•   - BaNES & Wiltshire
•   - Swindon DAWN patients
• Please refer to our DMARD Shared Care and Monitoring Guidance for further information (link below)
• 25mg and 50mg tablets

•  10mg, 25mg, 50mg and 100mg capsules

•   - BaNES and Wiltshire
•   - Swindon DAWN patients
• Please refer to our DMARD Shared Care and Monitoring Guidance below for further information
• 10mg, 15mg, 20mg and 100mg tablets

• 2.5mg tablets ONLY. There should be no prescribing of 10mg tablets. Please refer to NPSA guidance on reducing the risks of oral methotrexate. Patients should have patient held records while they are receiving treatment with any DMARD requiring regular monitoring (record cards and GP protocol advice available from rheumatology).
  
• The label on prescribed/dispensed methotrexate should state the instructions clearly, for example: ‘methotrexate 2.5mg tablets: (number of tablets) to be taken as a single dose ONCE A WEEK on XXX  DAY’.
• Note: Folic Acid 10mg is usually given ONCE A WEEK with methotrexate to reduce side effects. It should NOT be taken on the same day as the methotrexate.

•   - BaNES and Wiltshire
•   - Swindon DAWN patients.
• Please refer to our DMARD Shared Care and Monitoring Guidance below for further information.

• When self-adminstering subcutaneous methotrexate, patients should be maintained on the product they were initiated / trained on. Local formulary brands listed below: 
• Metoject^® 50mg/ml Injection prefilled pen 0.15ml (7.5mg), 0.2ml (10mg), 0.3ml (15mg), 0.4ml (20mg), 0.5ml (25mg), 0.6ml (30mg)
  Metoject is a pre-filled pen type device Local brand of choice
  Instruction guide for Metoject
• Zlatal^® 25mg/ml Injection prefilled syringe 0.3ml (7.5mg), 0.4ml (10mg), 0.5ml (12.5mg), 0.6ml (15mg), 0.7ml (17.5mg), 0.8ml (20mg), 0.9ml (22.5mg), 1ml (25mg)
  Zlatal is a prefilled syringe For those who need to use a syringe and needle
  Instruction guide for Zlatal
•   BaNES & Wiltshire patients.
•  for Swindon DAWN patients. 
• Please refer to our DMARD Shared Care and Monitoring Guidance for  further information.

•   - BaNES & Wiltshire patients
•   - Swindon DAWN patients
• Please refer to our DMARD Shared Care and Monitoring Guidance below for further information
• 500mg tablets

• 250mg vial, powder for reconstitution. Injection 125mg pre-filled syringe
• Commissioned by CCG for:
  • The treatment of rheumatoid arthritis in line with NICE TA195, TA375.
•  Commissioned by NHS England From Specialist Centres Only for:
  • Juvenile idiopathic arthritis in line with NICE TA373.
  • Paediatric indications where an adult NICE TA is available.
• Check individual Trust contracting arrangements.

• Injection 40mg prefilled syringe, prefilled pen
• Prescribe by brand. Biosimilar first-line option.  Imraldi^® first line biosimilar across BSW
• For rheumatoid arthritis in accordance with NICE TA375.

• Commissioned by NHS England From Specialist Centres Only for:
  • Juvenile idiopathic arthritis in line with NICE TA373.
  • Paediatric indications where an adult NICE TA is available
• Check Trust contracting arrangements.

• Intravenous infusion, powder for reconstitution 120mg vial; 400mg vial
• Commissioned by NHSE at specialist centres e.g RUH
• Non Formulary at GWH and SFT 

• Prefilled syringe 200mg.
• Use in accordance with NICE guidance and local pathways for RA, AS or PSA.
• Not routinely commissioned by NHS England for paediatric indications - see NHS England drugs list. 

• 25mg or 50mg solution for injection in pre-filled syringe or pen
• Prescribe by BRAND. Biosimilar should be used 1st line. BENEPALI^® is the biosimilar brand used locally in BSW. First-line etanercept brand. 

Commissioned by CCG for:

• Rheumatoid arthritis in accordance with NICE TA 375 and local pathway.
• Ankylosing spondylitis in accordance with NICE TA383 and local pathway
• Psoriatic arthritis in accordance with NICE TA199 and local pathway

Commissioned by NHS England from specialist centres only for:

• Juvenile idiopathic arthritis in line with NICE TA373.
• Paediatric patients in line with adult NICE TAs.
• Check Trust contracting arrangements.

• 50mg or 100mg pre-filled pen or syringe
• Commissioned by NHS England for paediatric indications.
• Commissioned by CCG for:
  • Psoriatic arthritis in accordance with NICE TAs and local pathway.
  • Rheumatoid arthritis in accordance with NICE TAs and local pathway.
  • Ankylosing spondylitis in accordance with NICE TAs and local pathway.

• 100mg powder for concentrate for solution for infusion
• All products should be prescribed by brand. Biosimilars should be used 1st line.
• For rheumatoid arthritis in accordance with NICE recommendations TA130 and TA195 and local pathway.
• For ankylosing spondylitis in accordance with NICE TA145 and TA140 and local pathway.
• For psoriatic arthritis in accordance with NICE TA199 and local pathway.
• Commissioned by NHS England for paediatric indications (where adult TA available). According to adult TAs (TA130, TA134, TA140, TA143, TA163, TA199) for the range of arthritis-related indications. 
• Check Trust contracting arrangements first before prescribing 

• Not routinely commissioned by NHS England for: connective tissue disease - interstitial lung disease, graft versus host disease, renal indications, sarcoidosis, progressive pulmonary sarcoidosis, uveitis or hidradenitis suppurativa.  

• 80mg solution for injection in pre-filled syringe or pen
• CCG commissioned as per NICE TA537 for psoriatic arthritis

• 100mg or 500mg concentrate for solution for infusion
• All products should be prescribed by brand. Biosimilars should be used where possible.
• CCG commissioned as per NICE TA195 for Rheumatoid Arthritis
• In accordance with NHS England policies only from specialist centres for:
  • paediatric rheumatology indications where adult TA is available (TA195).
  • ANCA-positive vasculitis as per NICE TA308 and NHS England Policy: A13/P/a.
  • SLE as per NHS England Policy: A13/PS/a.
  • Dermatomyositis and polymyositis.
  • Neuromyelitis optica, as per specification.
  • ABO-incompatible kidney transplants, as per specification.
  • Myasthenia gravis as per NHSE policy 170084P ( specialist centres only).
• Check Trust contracting arrangements first before prescribing

• 150 mg or 200mg solution for injection in pre-filled syringe
• 150 mg or 200mg solution for injection in pre-filled pen
• Commissioned by NHS England for:
  • For patients admitted to ICU with COVID-19- see link below.

• 150 mg solution for injection in pre-filled syringe or pen

• 162mg solution for injection in pre-filled syringe or pen.
• 20mg/ml concentrate for solution for infusion

Commissioned by CCG for:

• treating rheumatoid arthritis in line with NICE TA375

Commissioned by NHS England for:

• For patients admitted to ICU with COVID-19- see link below.
• Juvenile idiopathic arthritis in line with NICE TA238 and TA373.
• Giant cell arteritis in line with NICE TA518 (specialist centres/networks only)
• Adult-Onset Still’s Disease refractory to second-line therapy in line with clinical commissioning policy 170056P (specialist centres/networks only).
• Check Trust contracting arrangements first before prescribing

• 45mg/90mg pre-filled syringe or 45mg solution for injection (vials)
• Rheumatology
• CCG commissioned for for the treatment of active psoriatic arthritis in accordance with NICE TA340

•   - Bath, Salisbury & Swindon (except Swindon patients monitored via the DAWN system and provided with prescriptions by GWH)
•   - Swindon DAWN patients
• Please refer to our DMARD Shared Care and Monitoring Guidance for your respective locality for further information
• 500mg enteric coated tablets
• 500mg plain tablets

• 500 microgram tablets
• The dose of colchicine in acute gout is 1mg initially followed by 500 micrograms every 2-3 hours until relief of pain is obtained or vomiting or diarrhoea occurs or until a total dose of 6mg (12 tablets) has been reached. The course should not be repeated within 3 days.

• 80mg and 120mg
• To be prescribed only when patients have failed on Allopurinol in line with NICE TA below.
• SFT Febuxostat guidelines

• 1.5mg and 7.5mg infusion
• For Haematology/Oncology use only.

• Included on formulary as a diagnostic agent for myasthenia gravis.  

• Amber TLS across BSW when used for licensed indication
• RUH only, pyridostigmine is included on the formulary for the management of postural hypotension (unlicensed) RUH inpatient use (RED TLS)
• 60mg tablets

• Tablets 10mg
• Liquid 5mg in 5ml 
• Serious side-effects can follow abrupt withdrawal of baclofen; therapy should be discontinued by gradual dose reduction over at least 1-2 weeks (longer if symptoms occur)
• Bath only - Intrathecal Baclofen - Refer to the NHS Commissioning Board Clinical Policy D04/P/c: Intrathecal baclofen (ITB) 

• Swindon and Salisbury
•  BaNES
• 25mg and 100mg capsules
• Liver function tests should be performed before commencing dantrolene, and then repeated on discharge from hospital (or 6 weeks after starting therapy) and then at 3 monthly intervals. 

• 2mg, 5mg and 10mg tablets
• 10mg/2ml injection
• 2mg/5ml oral suspension
• 2.5mg, 5mg and 10mg rectal tubes
• For short term use only

• 2mg and 4mg tablets  

• 200mg and 300mg tablets
• MHRA Drug Safety Update June 2010  Quinine is not a routine treatment for nocturnal leg cramps, and should only be used when cramps regularly disrupt sleep. Treatment should be reviewed after 4 weeks to see whether there is any benefit and monitor for toxicity. Interrupt treatment at intervals of every 3 months to assess the need for further quinine treatment.

• Bath only - included on the formulary to aid taking blood for capillary blood gas sampling
• Non formulary in Swindon and Salisbury        

• Swindon only - for painful diabetic peripheral polyneuropathy.
• Cream containing 0.075% capsaicin (Axsain^®)
• For treatment of post herpetic neuralgia (after lesions have healed) & painful diabetic peripheral neuropathy

• Swindon only - for painful diabetic peripheral polyneuropathy (off-label)
• Cream containing 0.025% capsaicin (Zacin^®)
• For symptomatic relief in osteoarthritis. It may need to be used for 1-2 weeks before pain is relieved

• Pain clinic use only as per local policy below.