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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...
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
10.01.03  Expand sub section  Penicillamine
10.01.03  Expand sub section  Antimalarials
10.01.03  Expand sub section  Drugs affecting the immune response
Azathioprine
(Tablet)
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Formulary
  •  Amber with Shared Care - BaNES & Wiltshire
  •  Red - Swindon DAWN patients
  • Please refer to our DMARD Shared Care and Monitoring Guidance for further information (link below)
  • 25mg and 50mg tablets
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
 
Ciclosporin
(Capsule)
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Formulary
traffic lightRed
  •  10mg, 25mg, 50mg and 100mg capsules

 

 

 

 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
 
Leflunomide
(Tablet)
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Formulary
  •  Amber with Shared Care - BaNES and Wiltshire
  •  Red - Swindon DAWN patients
  • Please refer to our DMARD Shared Care and Monitoring Guidance below for further information
  • 10mg, 15mg, 20mg and 100mg tablets
 
Link  EMC Risk Minimisation materials: Arava (leflunomide)
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
 
Methotrexate
(Tablet)
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Formulary
  • 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.
  •  Amber with Shared Care - BaNES and Wiltshire
  •  Red - Swindon DAWN patients.
  • Please refer to our DMARD Shared Care and Monitoring Guidance below for further information.
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
Link  MHRA DSU Sep 2020: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
 
Methotrexate
(Injection)
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Formulary
  • 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
  •  Amber with Shared Care BaNES & Wiltshire patients.
  • Red for Swindon DAWN patients. 
  • Please refer to our DMARD Shared Care and Monitoring Guidance for  further information.
 
Link  BSW Guidance - Sharps Disposal and Prescribing Sharps Bins on FP10
Link  GWH Methotrexate Subcutaneous Injection Shared Care Document
Link  Methotrexate subcut Injection (RUH)
Link  SFT Methotrexate Subcutaneous Injections Shared Care Document
Link  MHRA DSU Sep 2020: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
 
Mycophenolate
(Tablet)
View adult BNF View SPC online
Formulary
  •  Amber with Shared Care - BaNES & Wiltshire patients
  •  Red - Swindon DAWN patients
  • Please refer to our DMARD Shared Care and Monitoring Guidance below for further information
  • 500mg tablets
 
Link  BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology
Link  MHRA DSU Dec 2015: Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men
Link  MHRA DSU Feb 2018: Mycophenolate mofetil, mycophenolic acid: updated contraception advice for male patients
Link  MHRA DSU Jan 2015: Mycophenolate mofetil (CellCept) and mycophenolic acid: risk of hypogammaglobulinaemia and risk of bronchiectasis
 
10.01.03  Expand sub section  Cytokine modulators to top
10.01.03  Expand sub section  Sulfasalazine
 ....
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
click to search medicines.org.uk
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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