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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...
10.03.02  Expand sub section  Rubefacients, topical NSAIDs, capsaicin, and poultices
10.03.02  Expand sub section  Topical NSAIDs and counter-irritants
Ibuprofen
(Topical)
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First Choice
traffic lightSelf
  • 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
 
Transvasin
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Formulary
traffic lightGreen
  • Bath only - included on the formulary to aid taking blood for capillary blood gas sampling
  • Non formulary in Swindon and Salisbury        

 

 
 
10.03.02  Expand sub section  Capsaicin
Capsaicin (Axsain)
(Topical)
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Formulary
traffic lightGreen
  • Amber 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
 
Link  Sep 2019 - Shortage of capsaicin cream
 
Capsaicin (Zacin)
(Topical)
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Formulary
traffic lightGreen
  • Amber 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
 
Link  Sep 2019 - Shortage of capsaicin cream
 
Capsaicin (Qutenza)
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Formulary
traffic lightRed
  • Pain clinic use only as per local policy below.  
 
Link  BSW CCG Qutenza patch (capsaicin 8%) for peripheral neuropathic pain in non-diabetic patients commissioning statement: low priority intervention
Link  USE OF QUTENZA PATCHES IN ADULTS for PERIPHERAL NEUROPATHIC PAIN IN NON-DIABETIC PATIENTS: PRIOR APPROVAL FORM
 
 ....
 Non Formulary Items
Algesal
(Topical gel)

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Non Formulary

NOT RECOMMENDED

 
Felbinac (Traxam)

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Non Formulary
 
Ibuprofen 10% gel

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Non Formulary

NOT RECOMMENDED

 
Ketoprofen 2.5%
(Oruvail , Powergel)

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Non Formulary
 
Movelat (Topical gel / cream)

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Non Formulary
 
Piroxicam (Feldene)

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Non Formulary
 
  
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
click to search medicines.org.uk
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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