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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
Notes:
Please contact EKHUFT Medicines Information ext. 7236001 or 01233 616001 with any queries.NHS
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10.01.01  Expand sub section  Non-steroidal anti-inflammatory drugs
 note 
STOPP v2 recommendation NSAID’s inappropriate to use in patients aged 65 years and older:
  • if eGFR < 50 ml/min/1.73m2 (risk of deterioration in renal function)
  • in combination with oral anticoagulants (risk of major gastrointestinal bleeding)
  • in combination with concurrent antiplatelet agent(s) without PPI prophylaxis (increased risk of peptic ulcer disease)
  • other than COX-2 selective agents with history of peptic ulcer disease or gastrointestinal bleeding, unless with concurrent PPI or H2 antagonist (risk of peptic ulcer relapse)
  • with severe hypertension (risk of exacerbation of hypertension) or severe heart failure (risk of exacerbation of heart failure)
  • for long-term use (>3 months) for symptom relief of osteoarthritis pain where paracetamol has not been tried (simple analgesics preferable and usually as effective for pain relief)
  • for long-term (>3 months) for chronic treatment of gout where there is no contraindication to a xanthine-oxidase inhibitor (e.g. allopurinol, febuxostat) (xanthine-oxidase inhibitors are first choice prophylactic drugs in gout)
  • with concurrent corticosteroids without PPI prophylaxis (increased risk of peptic ulcer disease).
  • Ibuprofen
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    First Choice
    Green
    Suspension, Tablets 
    Naproxen
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    Second Choice
    Green
    Tablets 
       
    Celecoxib (Celebrex)
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    Restricted Drug Restricted
    Green
    Capsules
  • Consultant ONLY initiation consistent with NICE clinical guidelines





    STOPP v2 recommendation COX-2 selective NSAIDs inappropriate to use in patients aged 65 years and older with concurrent cardiovascular disease (increased risk of myocardial infarction and stroke)
     
  •    
    Diclofenac
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    Restricted Drug Restricted
    Green
    Injection, Suppositories, Tablets,
  • Use as an alternative to naproxen when a liquid formulation (use soluble tablets), rectal or IV route is needed.
  • MHRA - Patients with serious underlying heart conditions, such as heart failure, heart disease, circulatory problems or a previous heart attack or stroke should no longer use diclofenac - see MHRA link
     
  • Link  MHRA advice on diclofenac(June 2013)
    Link  NPC: Diclofenac and CV risk review ( 2010)
       
    Etoricoxib (Arcoxia)
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    Restricted Drug Restricted
    Blue
    Tablets
  • Rheumatology ONLY
  • Initiation and standard dose reduced to 60mg a day in October 2016





    STOPP v2 recommendation COX-2 selective NSAIDs inappropriate to use in patients aged 65 years and older with concurrent cardiovascular disease (increased risk of myocardial infarction and stroke)


    UPDATE: ADVICE FROM MHRA: Prescribing information has been updated to introduce a lower recommended dose of 60 mg daily for patients with rheumatoid arthritis or ankylosing spondylitis 
  • Link  Etoricoxib (Arcoxia): revised dose recommendation for rheumatoid arthritis and ankylosing spondylitis
       
    Indometacin
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    Restricted Drug Restricted
    Green
    Capsules
  • Rheumatologists use only as an alternative NSAID
    Suppositories, for use in ERCP as prophylaxis of pancreatitis.
     
  •    
    Ketoprofen
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    Restricted Drug Restricted Capsules, Injections
  • Possible supply problems, Sanofi brand discontinued, current generic unavailable 
  •    
    Mefenamic Acid
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    Restricted Drug Restricted
    Green
    Tablets
  • Obs & Gynae 
  •    
    Meloxicam
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    Restricted Drug Restricted
    Green
    Tablets
  • Rheumatologists only as alternative NSAID 
  •    
    Piroxicam
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    Restricted Drug Restricted Capsules
  • Rheumatoligsts only as alternative NSAID
  • EMEA warning ek guidelines 
  •    
    10.01.01  Expand sub section  Aspirin
     ....
     Non Formulary Items
    Acelofenac  (Preservex)

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    Non Formulary
     
    Acemetacin  (Emflex)

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    Non Formulary
     
    Azapropazone  (Rheumox)

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    Non Formulary
     
    Dexibuprofen  (Seractil)

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    Non Formulary
     
    Dexketoprofen  (Keral)

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    Non Formulary
     
    Diclofenac with Misoprostol  (Arthrotec 50 and 75)

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    Non Formulary
     
    Dicolfenac Sodium  (Diclomax Retard)

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    Non Formulary
     
    Dicolfenac Sodium  (Diclomax SR)

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    Non Formulary
     
    Dicolfenac Sodium  (Motifene 75mg)

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    Non Formulary
     
    Dicolfenac Sodium  (Voltarol 75 mg SR)

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    Non Formulary
     
    Dicolfenac Sodium  (Voltarol Radid)

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    Non Formulary
     
    Dicolfenac Sodium  (Voltarol Retard)

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    Non Formulary
     
    Etodolac

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    Non Formulary
     
    Etodolac  (Lodine SR)

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    Non Formulary
     
    Fenbufen

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    Non Formulary
     
    Fenbufen  (Lederfen)

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    Non Formulary
     
    Fenoprofen  (Fenopron)

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    Non Formulary
     
    Flurbiprofen

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    Non Formulary
     
    Flurbiprofen  (Froben SR)

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    Non Formulary
     
    Flurbiprofen  (Froben)

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    Non Formulary
     
    Ibuprofen  (Brufen Retard)

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    Non Formulary
     
    Ibuprofen  (Brufen)

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    Non Formulary
     
    Ibuprofen  (Fenbid)

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    Non Formulary
     
    Indometacin

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    Non Formulary
     
    Ketoprofen  (Axorid®)

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    Non Formulary
     
    Ketoprofen  (Orudis)

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    Non Formulary
     
    Ketoprofen  (Oruvail)

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    Non Formulary
     
    Ketoprofen  (Oruvail MR)

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    Non Formulary
     
    Lumiracoxib  (Prexige)

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    Non Formulary




    STOPP v2 recommendation COX-2 selective NSAIDs inappropriate to use in patients aged 65 years and older with concurrent cardiovascular disease (increased risk of myocardial infarction and stroke)
     
    Mefenamic Acid  (Ponstan)

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    Non Formulary
     
    Meloxicam  (Mobic)

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    Non Formulary
     
    Nabumetone

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    Non Formulary
     
    Nabumetone  (Relifex)

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    Non Formulary
     
    Naproxen  (Naprosyn)

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    Non Formulary
     
    Naproxen  (Synflex)

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    Non Formulary
     
    Naproxen & esomeprazole  (Vimovo)

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    Non Formulary
     
    Naproxen with Misoprostol  (Napratec)

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    Non Formulary
     
    Piroxicam  (Brexidol)

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    Non Formulary
     
    Piroxicam  (Feldene)

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    Non Formulary
     
    Sulindac

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    Non Formulary
     
    Sulindac  (Clinoril)

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    Non Formulary
     
    Tenoxicam  (Mobiflex)

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    Non Formulary
     
    Tiaprofenic Acid

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    Non Formulary
     
    Tiaprofenic Acid  (Surgam)

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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 children's BNF
    click to search medicines.org.uk
    Link to SPCs
    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

    Traffic Light Status Information

    Status Description

    Amber

    Requires to be initiated by specialist for repeat GP Prescribing (Purple as per Eclipse East Kent Primary Care Formulary, may be top sliced) If a downloadable EKPG Prescribing Information Sheet exists in the formulary entry for the drug, it, or an URL (shortcut to webpage/document) should be sent to the GP. See also "Hints in how to incorporate documents for medicines information into clinical communications to GPs".  

    Amber 1

    Shared Care (Orange as per Eclipse East Kent Primary Care Formulary). See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    Amber 2

    Shared Care and topsliced (Orange as per Eclipse East Kent Primary Care Formulary) See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    Black

    A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications  

    Blue

    No comment on drug in East Kent Primary Care Formulary (Blue as per Eclipse East Kent Primary Care Formulary)  

    Brown

    Exceptional Use Only (Brown as per Eclipse East Kent Primary Care Formulary)   

    Green

    On East Kent Primary Care Formulary (Pink or Green as per Eclipse East Kent Primary Care Formulary)  

    Grey

    Not assessed/Not recommended (As per Eclipse East Kent Primary Care Formulary)  

    Red

    Hospital Only (As per Eclipse East Kent Primary Care Formulary)  

    RedRed

    Known to be commissioned for local NHS patients but only available to them from another provider than EKHUFT  

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