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NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
Notes:

Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

 Details...
10.01.02  Expand sub section  Corticosteroids
 note 

Treatment with corticosteroids in rheumatic diseases should be reserved for specific indications e.g. when other anti-inflammatory drugs are unsuccessful. 

Corticosteroids can induce osteoporosis.

See MHRA Drug Safety Update Aug 2017 for information and advice on the rare risk of central serous chorioretinopathy with local and systemic administration of corticosteroids.

10.01.02.01  Expand sub section  Systemic corticosteroids
Prednisolone
(Tablet)
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First Choice
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  • 5mg tablets
  • Do not prescribe EC tablets
  • Plain prednisolone tablets 5mg may be crushed and dispersed in water and administered orally or via NG/PEG tube (off-label).
  • Soluble tablets 5mg are considerably more expensive than both plain tablets 5mg and oral solution 1mg/ml.
 
10.01.02.02  Expand sub section  Local corticosteroids injections
Methylprednisolone Acetate
(Depo-Medrone)
(Injection)
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First Choice
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  • 120mg/3ml, 40mg/1ml and 80mg/2ml injection

 

 
Triamcinolone Acetonide
(Injection)
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First Choice
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  • Adcortyl® Intra-articular/Intradermal injection 10mg in 1mL
  • Kenalog® injection/Intramuscular injection 40mg in 1mL

June 2020 Update: Adcortyl 10mg in 1mL vials have been discontinued.

Adcortyl 50mg in 5mL vials remain available.  Kenalog 40mg in 1mL vials are also available. When prescribing and administering consider indication and most appropriate product for required dose. Ensure correct volume is drawn up. Ensure any remaining contents of vial are discarded and NOT used for multiple patients.

 
Hydrocortisone acetate
(Hydrocortistab)
(Injection)
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Formulary
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  • 25mg/1ml injection
 
 
 ....
 Non Formulary Items
Betamethasone
(Betnesol)
(injection - local)

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Non Formulary
 
Dexamethasone
(joint injection)

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Non Formulary
 
  
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
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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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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