Formulary


	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

Corticosteroids

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.

NICE CG177: Osteoarthritis

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Systemic corticosteroids

Prednisolone
(Tablet)

First Choice

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.

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Local corticosteroids injections

Methylprednisolone Acetate
(Depo-Medrone^®)
(Injection)

First Choice

120mg/3ml, 40mg/1ml and 80mg/2ml injection

Triamcinolone Acetonide
(Injection)

First Choice

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)

Formulary

25mg/1ml injection

....

Non Formulary Items

Betamethasone
(Betnesol^®)
(injection - local)

Non Formulary

Dexamethasone
(joint injection)

Non Formulary

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	High Cost Drug Approval System

Traffic Light Status Information

Status	Description
	RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.
	Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.
	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.
	These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.
	Suitable for patient to be directed to buy themselves
	Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.
	(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.
	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.