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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.02  Expand sub section  Drugs used in neuromuscular disorders
Mexiletine (Namuscla®)
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Formulary
Red
High Cost Medicine
BlueTeq

  • Approved for the treatment of myotonia in patients with non-dystrophic myotonic disorders in line with NICE and NHSE commissioning policy (SSC2001). 


 

 
Link  NICE TA748: Mexiletine for treating the symptoms of myotonia in non-dystrophic myotonic disorders
 
Nusinersen (Spinraza®)
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Formulary
Red
High Cost Medicine
  • 12mg solution for injection
  • Approved as an option for treating 5q spinal muscular atrophy (SMA) types 1, 2 or 3 in line with NICE.

 

 
Link  NHS England Urgent Clinical Commissioning Policy Statement (170018/P)
Link  NICE TA588: Nusinersen for treating spinal muscular atrophy
 
RisdiplamBlack Triangle (Evrysdi®)
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Formulary
Red
  • 0.75mg/1ml oral solution
  • Approved for treating spinal muscular atrophy in line with NICE
  • To be provided by Newcastle Hospitals homecare service only 
 
Link  NICE TA755: Risdiplam for treating spinal muscular atrophy
 
10.02.01  Expand sub section  Drugs which enhance neuromuscular transmission
Ataluren (Translarna®)
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Formulary
Red
  • Approved as an option for treating Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene in people 2 years and over who can walk - in line with NICE HST22.
 
Link  NICE HST22: Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene
 
10.02.01  Expand sub section  Anticholinesterases
Edrophonium Chloride
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Formulary
Red
 
 
Neostigmine
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Formulary
Green plus
  • 2.5mg in 1ml injection
 
 
Pyridostigmine Bromide
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Formulary
Green plus
 
 
10.02.01  Expand sub section  Immunosuppressant therapy
10.02.01  Expand sub section  Acetylcholine-release enhancers to top
10.02.02  Expand sub section  Skeletal muscle relaxants
Baclofen
(Tablets, SF liquid & injection)
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First Choice
Green
  • The following baclofen intrachecal injections (unlicensedunlicensed) are also approved; 36mg in 12ml, and 72mg in 12ml intrathecal injections.Red Traffic Light
 
Diazepam
(Tablets, solution, syrup, injection)
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First Choice
Green
  • Note: diazepam 10mg tablets are no longer on the formulary. 
 
Controlled Drug Cannabis extract (Sativex®)
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Formulary
Amber
  • cannabidiol 2.5mg/dronabinol 2.7mg per dose oromucosal spray
  • approved to treat moderate to severe spasticity in adults with multiple sclerosis in line with NICE Amber
 
Link  NENC Shared Care Protocol: Sativex (delta-9-tetrahydrocannabinol / cannabidiol) Oromucosal Spray
Link  NICE NG144: Cannabis-based medicinal products
 
Dantrolene
(Capsules)
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Alternatives
Green
 
 
Tizanidine
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Alternatives
Green plus
  • Approved for use on advice from neurologists when other treatments are unsuitable.
 
 
10.02.02  Expand sub section  Other muscle relaxants
10.02.02  Expand sub section  Nocturnal leg cramps
Quinine sulfate
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Formulary
Green
  • 300mg tablets
  • Approved for nocturnal leg cramps in accordance with MHRA advice
 
 
 ....
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
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), 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. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

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