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...

10.01.03

Drugs which suppress the rheumatic disease process

NICE CG177: Osteoarthritis

10.01.03

Penicillamine

10.01.03

Antimalarials

10.01.03

Drugs affecting the immune response

Azathioprine
(Tablet)

Formulary

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

BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology

Ciclosporin
(Capsule)

Formulary

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

BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology

Leflunomide
(Tablet)

Formulary

- 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

EMC Risk Minimisation materials: Arava (leflunomide)

BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology

Methotrexate
(Tablet)

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.

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

BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology

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)

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

BSW Guidance - Sharps Disposal and Prescribing Sharps Bins on FP10

GWH Methotrexate Subcutaneous Injection Shared Care Document

Methotrexate subcut Injection (RUH)

SFT Methotrexate Subcutaneous Injections Shared Care Document

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)

Formulary

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

BSW Summary of Shared Care Guidelines and Monitoring of Disease Modifying Drugs (DMARDs) in Adults Nov 2020 Rheumatology, Dermatology & Gastroenterology

MHRA DSU Dec 2015: Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men

MHRA DSU Feb 2018: Mycophenolate mofetil, mycophenolic acid: updated contraception advice for male patients

MHRA DSU Jan 2015: Mycophenolate mofetil (CellCept) and mycophenolic acid: risk of hypogammaglobulinaemia and risk of bronchiectasis

NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab

NICE TA375: Rheumatoid arthritis - Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept

NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

10.01.03

Cytokine modulators

10.01.03

Sulfasalazine

....

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.