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...

10.03

Drugs for the treatment of soft-tissue disorders and topical pain relief

10.03.01

Enzymes

10.03.02

Rubefacients, topical NSAIDs, capsaicin, and poultices

10.03.02

Topical NSAIDs and counter-irritants

Ibuprofen
(Topical)

First Choice

100g gel containing 5% ibuprofen
Fenbid brand is most cost effective
NICE clinical guideline 177 Osteoarthritis: Feb 2014 Paracetamol and/or topical NSAIDs should be offered to patients with knee or hand osteoarthritis before considering oral NSAIDs, COX-2 inhibitors or opioids

Osteoarthritis: care and management

Transvasin

Formulary

Bath only - included on the formulary to aid taking blood for capillary blood gas sampling
Non formulary in Swindon and Salisbury

10.03.02

Capsaicin

Capsaicin (Axsain^®)
(Topical)

Formulary

Swindon only - for painful diabetic peripheral polyneuropathy.
Cream containing 0.075% capsaicin (Axsain^®)
For treatment of post herpetic neuralgia (after lesions have healed) & painful diabetic peripheral neuropathy

Sep 2019 - Shortage of capsaicin cream

Capsaicin (Zacin^®)
(Topical)

Formulary

Swindon only - for painful diabetic peripheral polyneuropathy (off-label)
Cream containing 0.025% capsaicin (Zacin^®)
For symptomatic relief in osteoarthritis. It may need to be used for 1-2 weeks before pain is relieved

Sep 2019 - Shortage of capsaicin cream

Capsaicin (Qutenza^®)

Formulary

Pain clinic use only as per local policy below.

BSW CCG Qutenza patch (capsaicin 8%) for peripheral neuropathic pain in non-diabetic patients commissioning statement: low priority intervention

USE OF QUTENZA PATCHES IN ADULTS for PERIPHERAL NEUROPATHIC PAIN IN NON-DIABETIC PATIENTS: PRIOR APPROVAL FORM

....

Non Formulary Items

Algesal
(Topical gel)

Non Formulary

NOT RECOMMENDED

Collagenase (Xiapex^®)
(Injection)

Non Formulary

May 2020 - removed from formulary
NICE HAVE WITHDRAWN TA459 - collagenase clostridium histolyticum (Xiapex) is no longer available in the UK.

NICE TA459 : Collagenase clostridium histolyticum for treating Dupuytren’s contracture

Felbinac (Traxam^®)

Non Formulary

Ibuprofen 10% gel

Non Formulary

NOT RECOMMENDED

Ketoprofen 2.5%
(Oruvail ^®, Powergel^®)

Non Formulary

Movelat (Topical gel / cream)

Non Formulary

Piroxicam (Feldene^®)

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.