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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01  Expand sub section  Drugs used in rheumatic diseases and gout
10.01  Expand sub section  Osteoarthritis and soft-tissue disorders
 note  Hyaluronic acid is not supported in NICE Clinical Guidelines for use in osteoarthritis of the knee.

At UHL it has been supported for pain relief in osteoarthritis of shoulder only. (Red traffic light status)
Clinical support has been given for use in specific patients with painful osteoarthritis who have exhausted other therapies, surgery is not appropriate and who have previously responded to treatment  but funding is still outstanding so not available for use in this group yet.
10.01.01  Expand sub section  Non-steroidal anti-inflammatory drugs
 note 
  • Use the lowest effective dose for the shortest period to control symptoms and review the need for long-term treatment periodically. Pain relief should start soon after taking the first dose but an anti-inflammatory effect may take up to 3 weeks.
  • NSAIDS are associated with an increased cardiovascular (CV) risk. Low-dose ibuprofen (≤ 1200mg daily) or naproxen ≤1000mg daily have the lowest CV risk.
  • Low dose ibuprofen is associated with the lowest risk of GI toxicity. However all NSAIDs are associated with serious GI toxicity and they should be used cautiously in patients who are at high risk including patients >65 years and those on long term therapy. Use of a proton-pump inhibitor (PPI) reduces the risk, and should routinely be co-prescribed for anyone with osteoarthritis or rheumatoid arthritis and those ≥ 45 years with chronic low back pain PLUS anyone else at high risk of GI toxicity.
  • Renal failure may be provoked by NSAIDs. Avoid in patients with pre-existing or risk factors for renal impairment.
  • Topical NSAIDs and/or paracetamol should be considered first for hand and knee OA
Ibuprofen
View adult BNF View SPC online
First Choice
Green
Doses of 400mg only have marginal therapeutic benefit over 200mg doses and are associated with more adverse effects.
The suspension is significantly more expensive than tablets.
Ibuprofen is also suitable for women who are breast feeding.
 
Naproxen
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Second Choice
Green
Naproxen tablets/EC tablets 
   
Diclofenac Preparations
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Restricted Drug Restricted
Green
Restricted except for short term pre or peri-operative or post-natal use.
Recent trial data has shown an increased risk of cardiovascular events in patients treated with diclofenac. One of the Better Care Better Value targets is to reduce the amount of diclofenac prescribed as a percentage of all NSAID prescriptions. Leicestershire primary care has one of the worst ratios in the UK.
  • Contraindicated in patients with established cardiovascular disease. Avoid in patients with risk factors for cardiovascular disease.
  • For patients already taking diclofenac, consider changing to ibuprofen (1200mg per day or less) or naproxen (1000mg per day) if continued use is necessary.
  •  
       
    Sulindac
    View adult BNF View SPC online
    Restricted Drug Restricted
    Green
    For patients on lithium therapy if an NSAID is considered essential. Other NSAIDs may raise lithium levels and precipitate toxicity. 
       
    10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
     note 
    • Generally, when used alone immunosuppressants are not more effective than corticosteroids, but provide an alternative in selected cases. Immunosuppressants may be more effective in combination with steroids than treatment with a single drug and may allow a reduction in steroid dosage.
    • Methotrexate is suitable for moderate to severe active rheumatoid arthritis. Prescribers should be familiar with advice issued by the National Patient Safety Authority (NPSA) to reduce risk in prescribing of methotrexate.
    • The BNF recommends that only one strength of methotrexate tablet (usually 2.5 mg) is prescribed and dispensed.
    • Azathioprine, ciclosporin and cyclophosphamide are considered more toxic than methotrexate and are used in cases that have not responded to other disease modifying drugs. Ciclosporin is licensed for severe active rheumatoid arthritis when conventional second-line therapy is inappropriate or ineffective.
    • Disease-modifying drugs such as sulfasalazine, penicillamine, leflunomide, hydroxychloroquine and sodium aurothiomalate ('gold') may be used as alternatives to immunosuppressants in the management of rheumatoid arthritis.
    • Early treatment and control of inflammatory joint disease is essential to minimise joint damage and eventual disability. Prompt referral to a specialist is important. Patients with active rheumatoid disease should not be managed on non-steroidal anti-inflammatory drugs and/or corticosteroids in the long-term.
    • Response to all disease-modifying agents may be delayed for several months. Patients who fail to respond to one agent or suffer serious side effects may respond to another.
    Belimumab
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    BlueTeq

    Specialist rheumatology use. 
    For treatment of active autoantibody-positive systemic lupus erythematosus.
    In line with NICE TA 397

    Blueteq prior approval required before initiation

    Date of entry of decision to formulary:  March 2018

     
    Link  NICE TA 397: Belimumab for treating active autoantibody-positive systemic lupus erythematosus
       
    Gold (sodium aurothiomalate )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted Red Traffic Light  New patients Rheumatology use only


    Amber Traffic Light  Existing patients to continue injections in primary care under SCA 
    Link  SCA: DMARDs in treatment of Rheumatological Disease in Adults
       
    Methotrexate  (Subcutaneous)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist Rheumatology use only  
       
    Apremilast
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    Supported in line with NICE TA 433

    Date of entry of decision to formulary: May 2017 
    Link  NICE TA 433: Apremilast for treating active psoriatic arthritis
       
    Ixekizumab
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red

    For Psoriatic arthritis after inadequate response to DMARDs in line with NICE TA 537

    Implementation Date: November 2018 

     
    Link  NICE TA 537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
       
    10.01.03  Expand sub section  Cytokine modulators to top
    Baricitinib
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    Specialist Rheumatology. For use in line with NICE TA 466 for the treatment of severe rheumatoid arthritis only.

    Date of entry of decision to formulary: November 2017 
    Secukinumab
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist Rheumatology Use
    For use in line with NICE TA 407
    First line choice for ankylosing spondylitis on cost grounds
    Date of entry of decision to formulary: December 2016

    For use in line with NICE TA 445 for psoriatic arthritis.
    Date of entry of decision to formulary July 17
    First line choice for patients without concomitant moderate to severe plaque psoriasis on cost grounds(maintenance dose 150mg monthly)  
    Link  NICE TA 407: Secukinumab in ankylosing spondylitis
    Link  NICE TA 445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
       
    Abatacept
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist Rheumatology use only
    High cost drug excluded to tariff

    Date of entry of decision to Formulary: July 13 (TA 280) 
    Link  NICE TA 195: after failure of a TNF
    Link  NICE TA 280: Rheumatoid Arthritis - Abatacept
    Link  NICE TA 373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
       
    Adalimumab (Rheumatology)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    BlueTeq

    Specialist Rheumatology use only.
    High cost drug excluded to tariff
    For use only in line with NICE TA 130 (RA), TA 383 (AS and non-radiographic axial spondyloarthritis), TA 199 (PSA) and TA 195 (Following failure of a TNF) See links below.

    Blueteq prior approval required before initiation.

     
    Link  NICE TA 373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
       
    Certolizumab pegol
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist Rheumatology use only
    High cost drug excluded to tariff.
    Use in line with NICE TA 383 (AS and non-radiographic axial spondyloarthritis), NICE TA 375 and NICE TA 415(Rheumatoid Arthritis) Latter added January 2017
    Use in line with NICE TA 445 for psoriatic arthritis. Date of entry to formulary July 17 
    Link  NICE TA 375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed (Replaced TA186 Jan 2016)
    Link  NICE TA 383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
    Link  NICE TA 415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
    Link  NICE TA 445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
       
    Etanercept  (Erelzi® Rheumatology )
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist Rheumatology use only
    High cost drug excluded to tariff
    For use only in line with NICE TA 130 (RA), TA 383 (AS and non-radiographic axial spondyloarthritis), TA 199 (PSA) and TA 195 (Following failure of a TNF) See links below  
    Link  NICE TA 373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
       
    Golimumab
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist Rheumatology use only
    High cost drug excluded to tariff 
    Link  NICE TA 220: Golimumab for the treatment of psoriatic arthritis
    Link  NICE TA 225: Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs
    Link  NICE TA 383:TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis (Replaced TA 233 Feb 2016)
    Link  NICE TA 497: Golimumab for treating non-radiographic axial spondyloarthritis
       
    Infliximab (Inflectra®) (Rheumatology)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist Rheumatology use only
    High cost drug excluded to tariff
    For use only in line with NICE TA 130 (RA), TA 383 (AS), TA 199 (PSA) and TA 195 (Following failure of a TNF) See links below

    Prescribe by brand. Biosimilar infliximab (Inflectra) to be used for new patients  
       
    Rituximab (Truxima®) (Rheumatology)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist Rheumatology use only
    High cost drug excluded to tariff, CCG commissioned. In Rheumatology indications the biosimilar Truxima should be used for all new treatment courses

    Use in SLE commissioned by NHSE in line with policy below only  
    Link  NHSE Commissioning Policy: Rituximab for the treatment of Systemic Lupus Erythematosus in adults
       
    Tocilizumab
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine

    IV: Specialist Rheumatology use only in line with NICE TA 247

    Treating giant cell arteritis. Use in line with NICE TA 518

    Treatment of Stills disease in line with NHSE Commissioning Policy

    Date of entry of decision to formulary: July 2018

    High cost drug excluded to tariff
    Subcutaneous preparation also supported

     
    Link  Leicestershire Evaluation: Tocilizumab SC in Rheumatoid Arthritis
    Link  NHSE Clinical Commissioning Policy: Anakinra/tocilizumab for the treatment of Adult-Onset Still’s Disease refractory to second-line therapy (adults)
    Link  NICE TA 247: Tocilizumab
    Link  NICE TA 373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
    Link  NICE TA 518: Tocilizumab for treating giant cell arteritis
       
    Ustekinumab (Rheumatology)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist Rheumatology use in line with NICE TA 340

    Date of entry of decision to formulary: September 2015 
    Link  NICE TA 340: Ustekinumab in psoriatic arthritis
       
    Sarilumab (Kevzera®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist rheumatology use only. High cost drug excluded to tariff, CCG commissioned.
    For use in line with NICE TA 485 for the treatment of moderate to severe rheumatoid arthritis only
    Date of entry of decision to formulary: January 2018 
    Link  NICE TA 485: Sarilumab for moderate to severe rheumatoid arthritis
       
    Tofacitinib (XELJANZ®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    CCG

    Specialist Rheumatology. For use in line with NICE TA 480 for the treatment of severe rheumatoid arthritis only.
    Date of entry of decision to formulary: January 2018

    Specialist Rheumatology. For use in line with NICE TA 543 for the treatment of active psoriatic arthritis after inadequate response to DMARDs 
    Date of entry of decision to formulary: January 2019

     
    Link  NICE TA 480: Tofacitinib for moderate to severe rheumatoid arthritis
    Link  NICE TA 543: ofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
       
    Anakinra (Kineret®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red

    For treatment of Still’s disease, periodic fevers and autoimflammatory diseases only as per NHSE commisioning statement.
    All other indications non-formulary.

     
    Link  NHSE Clinical Commissioning Policy: Anakinra/tocilizumab for the treatment of Adult-Onset Still’s Disease refractory to second-line therapy (adults)
       
    10.01.04  Expand sub section  Gout and cytotoxic-induced hyperuricaemia
    10.01.04  Expand sub section  Acute attacks of gout
     note 
    • Treat acute attacks of gout with a non-steroidal anti-inflammatory drug (NSAID) for about a week. High doses are necessary, at least for the first day or two or until the pain is controlled. Avoid aspirin in gout.
    • Recommended choices are below. Etoricoxib is also licensed for acute gouty arthritis but an MHRA alert advises that it may be associated with more frequent and severe hypertension than some other NSAIDs and selective COX-2 inhibitors, particularly at high doses. Therefore, special attention should be paid to blood pressure monitoring during treatment. If blood pressure rises significantly, alternative treatment should be considered.
    • A short course of prednisolone is sometimes used.
    Naproxen
    View adult BNF View SPC online
    First Choice
    Green
     
    Diclofenac
    View adult BNF View SPC online
    Second Choice
    Green
    Short term use 
       
    Indometacin
    View adult BNF View SPC online
    Second Choice
    Green
    Less commonly prescribed. 
       
    Colchicine
    View adult BNF View SPC online
    Restricted Drug Restricted
    Green
    Acute gout, where NSAIDs are not suitable e.g. those with heart failure, renal impairment or taking anticoagulants. Adverse effects frequently limit its use. In difficult or resistant cases seek specialist advice. 
       
    10.01.04  Expand sub section  Long-term control of gout
     note  Prophylaxis with allopurinol is necessary for recurrent acute attacks, chronic gout and symptomatic hyperuricaemia (with urate nephropathy). It may increase the incidence of acute attacks during the first few months of treatment therefore a NSAID e.g. ibuprofen 400mg three times daily should be given for 1-2 months (colchicine 500micrograms twice daily is suitable for patients that cannot take NSAIDs). Prophylactic drugs should never be commenced until an acute attack has fully resolved, as symptoms are likely to be worsened. 

    Allopurinol
    View adult BNF View SPC online
    First Choice
    Green
    Allopurinol and its metabolites are renally excreted and may accumulate if kidney function is impaired. In severe renal insufficiency, it may be advisable to use less than 100 mg per day or to use single doses of 100mg at longer intervals than one day. 
    Febuxostat
    View adult BNF View SPC online
    Restricted Drug Restricted
    Green
    For use only in line with NICE TA 164 for patients who are intolerant of allopurinol or where allopurinol is contra-indicated. 
    Link  NICE TA 164: Febuxostat
       
    10.01.04  Expand sub section  Hyperuricaemia associated with cytotoxic drugs
    Rasburicase
    View adult BNF View SPC online
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist prescribing only
    High cost drug excluded to tariff commissioned by NHSE 
       
    10.01.05  Expand sub section  Other drugs for rheumatic diseases to top
    Chondrosphere (Spherox®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red

    Symptomatic articular cartilage defects of the knee in adults.

    Use in Line with NICE TA 508

    Date of entry of decision to Formulary: June 2018

     
    Link  NICE TA 508: Autologous chondrocyte implantation using chondrosphere for treating symptomatic articular cartilage defects of the knee
       
    10.02  Expand sub section  Drugs used in neuromuscular disorders
     note 
    Ataluren (Translarna)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    BlueTeq

    Duchenne muscular dystrophy in line with NICE HST3

    Blueteq prior approval required before initiation

     
    Link  NICE HST 3: Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene
       
    10.02.01  Expand sub section  Drugs which enhance neuromuscular transmission
    10.02.01  Expand sub section  Acetylcholine-release enhancers
    10.02.02  Expand sub section  Skeletal muscle relaxants
    Quinine Sulphate 300mg
    View adult BNF View SPC online
    Formulary
    Green
    For leg cramps.
    Review benefits regularly.  
       
    10.03.01  Expand sub section  Enzymes to top
    Collagenase
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    High Cost Medicine
    Specialist use only in line with NICE TA 459

    Date of entry of decision to formulary: October 2017  
    Link  NICE TA 459: Collagenase clostridium histolyticum for treating Dupuytren’s contracture
       
    10.03.02  Expand sub section  Rubefacients, topical NSAIDs, capsaicin, and poultices
    10.03.02  Expand sub section  Topical NSAIDs and counter-irritants
     note 
    • NICE CG 59 osteoarthritis recommends that consideration be given to offering topical NSAIDs for pain relief in addition to core treatment for people with knee or hand osteoarthritis.
    • Topical capsaicin 0.025% should be considered as an adjunct to core treatment for knee or hand osteoarthritis.
    • Rubefacients are not recommended for the treatment of osteoarthritis.
    Ibuprofen 5% Gel
    View adult BNF View SPC online
    First Choice
    Green
     
    Capsacin cream
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted
  • Green Traffic Light For use in line with NICE CG173 for management of neuropathic pain
  • Green Traffic Light For use in line with NICE CG17 for management of Osteoarthritis 
  • Link  NICE CG 173: Neuropathic pain in adults
    Link  NICE CG 177: Osteoarthritis care and management
       
    Capsaicin Patch (Qutenza®)
    View adult BNF View SPC online  Track Changes
    Restricted Drug Restricted
    Red
    Supported for use by the pain clinic only. For use only in patients with peripheral neuropathic pain (non-diabetic) who have tried and not responded to other pain relief - amitriptyline, gabapentin, pregabalin, duloxetine, oxycodone, tramadol and lidocaine patch
    CCG agreement for pass through payment agreed locally

     
       
     ....
     Non Formulary Items
     (Actipatch®)

    View adult BNF View SPC online Track Changes
    Non Formulary
    Black
     
     (Arthrotec®)

    View adult BNF View SPC online
    Non Formulary
     
    Amifampridine  (Firdapse®)

    View adult BNF View SPC online
    Non Formulary
    Black
    For Lambert-Eaton myasthenic syndrome
    Not commissioned by NHSE. See policy below
    Link  NHSE Commissioning Policy: Amifampridine (Firdapse®)
     
    Anakinra

    View adult BNF View SPC online
    Non Formulary
    Black
    Not supported for use in rheumatoid arthritis as recommended by NICE Clinical Guideline 79
    Not supported by TAS for gout
    Not routinely commissioned by NHSE (IFR only)
    Link  Leicestershire Evaluation: Anakinra in Gout
     
    Anakinra  (Kineret®)

    View adult BNF View SPC online Track Changes
    Non Formulary
    Black

    Cryopyrin-Associated Periodic Syndromes (CAPS).

    Rheumatoid arthritis - Not recommended by NICE NG100.

    Link  NICE NG 100: Rheumatoid arthritis in adults: management
     
    Canakinumab

    View adult BNF View SPC online
    Non Formulary
    Black
     
    Cannabis Extract Spray  (Sativex®)

    View adult BNF View SPC online
    Non Formulary
    Black
    Not supported for use by East Midlands
    Link  East Midlands Policy: Sativex
    Link  Leicestershire Evaluation: Sativex in Pain and Spasticity
     
    Capsaicin Patch  (Qutenza®)

    View adult BNF View SPC online Track Changes
    Non Formulary
    Black
    For diabetic neuropathy
    Link  Leicestershire Evaluation: Qutenza in Diabetic Neuropathy
     
    Celecoxib  (Celebrex®)

    View adult BNF View SPC online
    Non Formulary
     
    Deep Freeze®

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    As per LMSG guidance on low priority prescribing
     
    Deep Heat®

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    As per LMSG guidance on low priority prescribing
     
    Diclofenac Sodium Injection  (Dyloject®)

    View adult BNF View SPC online
    Non Formulary
    Black
    Supported by TAS clinically in 2008 but funding not supported
    Link  Leicestershire Evaluation: Dyloject® in Analgesia
     
    Fampridine  (Fampyra®)

    View adult BNF View SPC online
    Non Formulary
    Black
    Not supported by TAS due to lack of clinical evidence for efficacy
    Funding not supported / not commissioned by NHSE
    Link  Leicestershire Evaluation: Fampridine in MS
    Link  NHSE Commissioning Policy:Fampridine for Multiple Sclerosis
     
    Flurbiprofen

    View adult BNF View SPC online
    Non Formulary
     
    Glucosamine

    View adult BNF View SPC online Track Changes
    Non Formulary
    Black
    This drug is classified as BLACK on the Leicestershire Traffic light list i.e. is not recommended for prescribing as per NICE CG177
    Link  LMSG: Low Priority Prescribing
    Link  NICE CG 177: Osteoarthritis: care and management
     
    Meloxicam

    View adult BNF View SPC online Track Changes
    Non Formulary
     
    Naproxen + Esomeprazole  (Vimovo®)

    View adult BNF View SPC online
    Non Formulary
    Black
     
    Pegloticase

    View adult BNF View SPC online Track Changes
    Non Formulary
    Black
    Not available. Not supported by NICE

    Date of entry of decision to Formulary: June 2013
    Link  NICE TA 291
     
    Piroxicam

    View adult BNF View SPC online Track Changes
    Non Formulary
     
    Tocilizumab  (RoActemra®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    The treatment of chimeric antigen receptor (CAR) T cell-induced severe or life-threatening cytokine release syndrome (CRS) in adults and paediatric patients 2 years of age and older.

     
      
    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 children's BNF
    click to search medicines.org.uk
    Link to SPCs
    SMC
    Scottish Medicines Consortium
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Black

    Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety. All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry   

    Red

    Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).  

    Amber SCA

    Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.   

    Amber Simple

    Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.  

    Green Conditional

    Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence see comments under individual entries.   

    Green

    Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.   

    netFormulary