Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
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10.01.01 |
Non-steroidal anti-inflammatory drugs |
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Ibuprofen
(Oral)
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First Choice

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- 200mg, 400mg and 600mg tablets
- Oral suspension
- For minor conditions associated with pain and inflammation, patients should self-care in the first instance.
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MHRA DSU June 2015: High-dose ibuprofen (¡Ý2400mg/day): small increase in cardiovascular risk
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Naproxen
(Tablets)
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Second Choice

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- 250mg and 500mg tablets
- Oral suspension and effervescent tablets available
- No evidence for GI benefit of EC preparation - use standard tablets.
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Diclofenac
(Oral)
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Third Choice
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 - 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
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MHRA DSU Dec 2014: Diclofenac: new contraindications and warnings
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Diclofenac
(Rectal & Injection)
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Third Choice

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- 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.
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MHRA DSU Dec 2014: Diclofenac: new contraindications and warnings
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Diclofenac
(Akis®)
(Injection)
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Third Choice
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 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.
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MHRA DSU Dec 2014: Diclofenac: new contraindications and warnings
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Celecoxib
(Celebrex®)
(Capsule)
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Formulary

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- Salisbury only
- Non formulary in BaNES and Swindon
- 100mg and 200mg capsules
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Etodolac
(Tablet, capsule)
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Formulary

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- Salisbury only
- Non formulary in BaNES and Swindon
- 300mg capsules
- 600mg tablets and 600mg MR tablets
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Etoricoxib
(Tablet)
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Formulary
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 - BaNES - Second line for treament of Ankylosing Spondylitis ONLY.
 - Swindon - Reserved for severe inflammatory arthritis unresponsive or intolerant to other NSAIDS.
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 - 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.
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MHRA DSU Oct 2016: Etoricoxib (Arcoxia): revised dose recommendation for rheumatoid arthritis and ankylosing spondylitis
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Indometacin
(Capsules and suppositories)
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Formulary

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- BaNES and Swindon only
- Non formulary in Salisbury
- 25mg and 50mg
- 100mg suppositories
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Mefenamic Acid
(Tablets and capsules)
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Formulary

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- 500mg tablets
- 250mg capsules
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Meloxicam
(Tablets)
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Formulary
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 - 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.
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Phenylbutazone
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Formulary

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- 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.
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10.01.01 |
Aspirin |
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Non Formulary Items |
Aceclofenac

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Non Formulary
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Acemetacin
(Emflex®)

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Non Formulary
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Azapropazone
(Rheumox®)

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Non Formulary
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Celecoxib
(Onsenal®)

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Non Formulary
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Dexibuprofen
(Seractil®)

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Non Formulary
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Diclofenac with Misoprostol
(Arthrotec 50 and 75®)

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Non Formulary
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Fenbufen

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Non Formulary
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Fenoprofen
(Fenopron®)

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Non Formulary
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Flurbiprofen

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Non Formulary
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Ibuprofen and famotidine
(Duexis®)

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Non Formulary
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Ketoprofen

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Non Formulary
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Nabumetone

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Non Formulary
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Nabumetone
(Relifex®)

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Non Formulary
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Naproxen & esomeprazole
(Vimovo®)

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Non Formulary
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Sulindac

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Non Formulary
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Tenoxicam
(Mobiflex®)

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Non Formulary
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Tiaprofenic Acid

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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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High Cost Drug Approval System |
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Traffic Light Status Information
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