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

10.02  Expand sub section  Drugs used in neuromuscular disorders
10.02.01  Expand sub section  Drugs which enhance neuromuscular transmission
10.02.01  Expand sub section  Anticholinesterases
Edrophonium Chloride
View adult BNF View SPC online
traffic lightRed
  • Included on formulary as a diagnostic agent for myasthenia gravis.  
Pyridostigmine Bromide
View adult BNF View SPC online
  • Amber Amber TLS across BSW when used for licensed indication
  • Red RUH only, pyridostigmine is included on the formulary for the management of postural hypotension (unlicensed) RUH inpatient use (RED TLS)
  • 60mg tablets
10.02.02  Expand sub section  Skeletal muscle relaxants
View adult BNF View SPC online
traffic lightGreen
  • Tablets 10mg
  • Liquid 5mg in 5ml 
  • Serious side-effects can follow abrupt withdrawal of baclofen; therapy should be discontinued by gradual dose reduction over at least 1-2 weeks (longer if symptoms occur)
  • Bath only - Intrathecal Baclofen - Refer to the NHS Commissioning Board Clinical Policy D04/P/c: Intrathecal baclofen (ITB) 
View adult BNF View SPC online
  • Green Swindon and Salisbury
  • Amber BaNES
  • 25mg and 100mg capsules
  • Liver function tests should be performed before commencing dantrolene, and then repeated on discharge from hospital (or 6 weeks after starting therapy) and then at 3 monthly intervals. 
Diazepam (Muscle relaxant)
(Oral, IV and rectal)
View adult BNF View SPC online
traffic lightGreen
  • 2mg, 5mg and 10mg tablets
  • 10mg/2ml injection
  • 2mg/5ml oral suspension
  • 2.5mg, 5mg and 10mg rectal tubes
  • For short term use only


View adult BNF View SPC online
traffic lightAmber
  • 2mg and 4mg tablets  
10.02.02  Expand sub section  Nocturnal leg cramps to top
View adult BNF View SPC online
traffic lightGreen
  • 200mg and 300mg tablets
  • MHRA Drug Safety Update June 2010  Quinine is not a routine treatment for nocturnal leg cramps, and should only be used when cramps regularly disrupt sleep. Treatment should be reviewed after 4 weeks to see whether there is any benefit and monitor for toxicity. Interrupt treatment at intervals of every 3 months to assess the need for further quinine treatment.
Link  Quinine: not to be used routinely for nocturnal leg cramps
Link  Quinine: reminder of dose-dependent QT-prolonging effects; updated medicine interactions
 Non Formulary Items
Controlled Drug  Cannabis extract

View adult BNF View SPC online
Non Formulary

The publication of the NICE guideline that covers prescribing of cannabis-based medicinal products for people with intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy.  The BSW commissioning position on sativex can be found on the link below.

Link  BSW Sativex® spray (delta-9-tetrahydrocannabinol (THC): cannabidiol (CBD)) for treatment for symptom improvement in adult patients with moderate to severe spasticity due to multiple sclerosis (MS) Jan 2020 (not commissioned)
Distigmine Bromide

View adult BNF View SPC online
Non Formulary

View adult BNF View SPC online
Non Formulary
Nusinersen (Spinraza)

View adult BNF View SPC online
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
Display tracking information
click to search
Link to adult BNF
click to search
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.