netFormulary NHS
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
 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter

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.


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

10.01.04  Expand sub section  Gout and cytotoxic-induced hyperuricaemia
10.01.04  Expand sub section  Acute attacks of gout
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  • 500 microgram tablets
  • The dose of colchicine in acute gout is 1mg initially followed by 500 micrograms every 2-3 hours until relief of pain is obtained or vomiting or diarrhoea occurs or until a total dose of 6mg (12 tablets) has been reached. The course should not be repeated within 3 days.
Link  MHRA CAS Alert Feb 2021 Colchicine in the Management of COVID-19 (SARS-CoV 2) Positive Patients - Trial Use Only
Link  MHRA DSU Dec 2014: Colchicine: extremely toxic in overdose
10.01.04  Expand sub section  Long-term control of gout
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First Choice
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  • 100mg and 300mg tablets
  • The dose of allopurinol should be reduced in patients with renal failure.
Febuxostat (Adenuric®)
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Second Choice
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  • 80mg and 120mg
  • To be prescribed only when patients have failed on Allopurinol in line with NICE TA below.
  • SFT Febuxostat guidelines


Link  MHRA DSU July 2019: Febuxostat (Adenuric): increased risk of cardiovascular death and all-cause mortality in clinical trial in patients with a history of major cardiovascular disease
Link  MHRA DSU Dec 2014: Febuxostat (Adenuric„): stop treatment if signs or symptoms of serious hypersensitivity
Link  NICE TA164 Dec 2008: Febuxostat for the management of hyperuricaemia in people with gout
10.01.04  Expand sub section  Hyperuricaemia associated with cytotoxic drugs
Rasburicase (Fastertec®)
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High Cost Medicine
  • 1.5mg and 7.5mg infusion
  • For Haematology/Oncology use only.
 Non Formulary Items
Lesinurad (Zurampic®)

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Non Formulary
Link  NICE TA506: Lesinurad for treating chronic hyperuricaemia in people with gout

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Non Formulary

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Non Formulary
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
Track Changes
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Link to adult BNF
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Link to SPCs
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHS England
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.