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Sunderland Joint Formulary
NHS Sunderland Clinical Commissioning Group
South Tyneside and Sunderland NHS Foundation Trust
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.02  Expand sub section  Drugs used in neuromuscular disorders
Nusinersen
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Formulary
Red

Nusinersen is recommended as an option for treating 5q spinal muscular atrophy (SMA) only if:

  • people have pre-symptomatic SMA, or SMA types 1, 2 or 3 and

  • the conditions in the managed access agreement are followed.

 
Link  NICE TA 588: Nusinersen for treating spinal muscular atrophy
   
Mexiletine (NaMuscla®)
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Formulary
Red

Capsules: 167mg (NaMuscla® 167mg equivalent to 200mg mexiletine HCl) 

ONLY APPROVED FOR USE ON THE FORMULARY FOR THE FOLLOWING INDICATIONS. HOSPITAL ONLY DRUG FOR ALL INDICATIONS

* Myotonia in non-dystrophic myotonic disorders

* Neuropathic pain (unlicensed indication)

* Ventricular arrhythmia (unlicensed indication) 
   
10.02.01  Expand sub section  Drugs which enhance neuromuscular transmission
10.02.01  Expand sub section  Anticholinesterases
Neostigmine
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Formulary
Green +
Tablets: 15 mg
Injection: 2.5 mg/1 mL
 
   
Edrophonium Chloride
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Alternatives
Red

Injection: 10 mg/1 mL
Hospital use only. This is only used as a diagnostic test in some suspected cases of MG. It has a brief effect to improve the symptoms.

 
   
Pyridostigmine Bromide (Mestinon®)
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Alternatives
Green +
Tablets: 60 mg
Used as the standard initial symptomatic treatment for MG. Maximum beneficial dose is usually 360mg daily. Steroids and other immunosuppressant drugs are used to obtain remission those with more severe disease who do not respond sufficiently well to pyridostigmine. 
   
10.02.01  Expand sub section  Immunosuppressant therapy
10.02.01  Expand sub section  Acetylcholine-release enhancers to top
Diaminopyridine
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Formulary
Red
Tablets: 20mg 
   
10.02.02  Expand sub section  Skeletal muscle relaxants
Baclofen
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Formulary Tablets: 10 mg
Oral solution (sugar-free available): 5 mg/5 mL
 
   
Controlled Drug Cannabis extract (Sativex®)
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Formulary
Amber

Oromucosal spray: cannabidiol 2.5mg/dronabinol 2.7mg per dose

Approved to treat moderate to severe spasticity in adults with multiple sclerosis in line with NICE NG144

 
Link  NICE NG144: Cannabis-based medicinal products
   
Dantrolene
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Formulary
Green +
Capsules: 25 mg, 100 mg 
   
Diazepam
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Formulary

Tablets: 2 mg, 5 mg
Oral solution (sugar-free available): 2 mg/5 mL

 
   
Tizanidine
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Formulary
Green +
Tablets: 2 mg, 4 mg 
   
10.02.02  Expand sub section  Other muscle relaxants
10.02.02  Expand sub section  Nocturnal leg cramps
Quinine
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Formulary

Tablets: 300mg

The MHRA advises:

  • Quinine should not be used routinely for nocturnal leg cramps
  • Only consider use when cramps cause regular disruption of sleep.
  • Trial for 4 weeks and discontinue if no benefit.
  • Reassess after 3 months. 
 
   
 ....
 Non Formulary Items
Amifampridine  (Firdapse)

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Non Formulary
High Cost Medicine
 
Ataluren  (Translarna®)

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Non Formulary
 
Carisoprodol  (Carisoma®)

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Non Formulary
 
Distigmine Bromide

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Non Formulary
 
Methocarbamol  (Robaxin®)

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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
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

Red

Drugs for hospital use or use by a specialist within specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the appropriate hospital clinician or specialist. These drugs should only be prescribed under the direct supervision of that clinician or specialist and are not suitable for shared care arrangements. The drug should be supplied via the hospital or specialist centre for the duration of treatment.   

Amber

These are specialist drugs which must be initiated by secondary care specialist prescribers, but with the potential to transfer prescribing to primary care within written and agreed shared care protocols and according to the agreed process for transfer of care. For these drugs, in order to ensure patient safety, some aspects of care must remain with the specialist due to their complexity e.g. monitoring of disease or drug response. Other more routine aspects can be transferred to the GP e.g. monitoring of adverse effects and supply of the medicine. The specific responsibilities of the specialist and GP are defined in the shared care agreement for each drug. Shared care agreements are still under development for some amber drugs. Until these are available, it would be expected that any shared care request from secondary care to a GP would be accompanied by written information which defines prescribing and monitoring responsibilities. The hospital specialist should also provide the GP with enough information and support to allow the safe transfer and ongoing management of prescribing into primary care.   

Green +

Drugs which should usually be initiated in secondary care, or by a specialist clinician, but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case.  

Green

These are defined as new and established drugs, which may be prescribed, initiated, changed or maintained on FP10 by the GP and, if appropriate, discontinued without recourse to secondary care. N.B. DRUGS NOT IDENTIFIED IN THE FORMULARY BY A RED, AMBER OR GREEN+ SYMBOL ARE CLASSIFIED AS GREEN.   

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