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NHS Herefordshire Clinical Commissioning Group
Wye Valley NHS Trust
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
Baricitinib (Olumiant)
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Restricted Drug Restricted
Red
High Cost Medicine

For moderate to severe rheumatoid arthritis in line with TA466

 
   
Golimumab (Simponi)
(Axial spondyloarthritis)
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Restricted Drug Restricted
Red
High Cost Medicine

In line with NICE technology appraisals and local guidance

 
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
   
Sarilumab (Kevzara)
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Restricted Drug Restricted
Red

 In line with NICE TA485

 
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
   
Tofacitinib citrate
(Xeljanz)
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Restricted Drug Restricted
Red
High Cost Medicine

For moderate to severe rheumatoid arthritis in line with TA480

 
Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
   
10.01.03  Expand sub section  Gold
Soldium Aurothomalate (Myocrisin)
(Gold)
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Restricted Drug Restricted
Amber

Rheumatology - shared care

 

 
   
10.01.03  Expand sub section  Penicillamine
Penicillamine
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Restricted Drug Restricted
Amber

Rheumatology shared care

 

 
   
10.01.03  Expand sub section  Antimalarials
Chloroquine
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Restricted Drug Restricted
Amber
 
   
Hydroxychloroquine
(Rheumatology)
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Restricted Drug Restricted
Amber

Rheumatoid Arthritis Only

 

 
   
10.01.03  Expand sub section  Drugs affecting the immune response to top
Abatacept (Orencia)
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Restricted Drug Restricted
Red
High Cost Medicine

 In line with NICE technology appraisals and local guidance

 
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
   
Adalimumab (Humira)
(rheumatology)
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Restricted Drug Restricted
Red
High Cost Medicine

 In line with NICE technology appraisals and local guidance

 
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA455 : Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young peopl
Link  NICE TA460 : Adalimumab and dexamethasone for treating non-infectious uveitis
   
Cytotoxic Drug Azathioprine
(rheumatology)
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Restricted Drug Restricted
Amber
 
   
Certolizumab Pegol (Cimzia)
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Restricted Drug Restricted
Red
High Cost Medicine

 In line with NICE technology appraisals and local guidance

 
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
Link  NICE TA445 : Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARD
   
Ciclosporin
(Rhematology)
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Restricted Drug Restricted
Red Amber

Restricted: Consultant initiation only.

Hospital Only for new renal transplant patients

Prescribe by brand to ensure bioequivalence.

 
   
Cytotoxic Drug Cyclophosphamide
(Rheumatology)
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Restricted Drug Restricted
Amber

Immunosuppressant in Rheumatology - AMBER

 

 
   
Etanercept (Benepali)
(Biosimilar)
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Restricted Drug Restricted
Red

  In line with NICE technology appraisals and local guidance

 
Link  NICE TA35: Adult psoriasis
Link  NICE TA195: rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Etanercept (Enbrel)
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Restricted Drug Restricted
Red
High Cost Medicine

 In line with NICE technology appraisals and local guidance

 
Link  NICE TA35: Adult psoriasis
Link  NICE TA195: Rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for JIA
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA455 : Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people
   
Etanercept (Erelzi)
(Biosimilar)
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Restricted Drug Restricted
Red

 In line with NICE technology appraisals and local guidance

 
   
Golimumab (Simponi)
(Rheumatology)
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Restricted Drug Restricted
Red
High Cost Medicine

In line with NICE technology appraisals and local guidance

 
Link  NICE TA220: psoriatic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Infliximab (Remicade)
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Restricted Drug Restricted
Red
High Cost Medicine

In line with NICE technology appraisals and local guidance

 
Link  NICE TA195: Rheumatoid arthritis (after failure of a TNF inhibitor)
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Leflunomide
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Restricted Drug Restricted
Amber

Restricted: Consultant rheumatologist only

 
   
Cytotoxic Drug Methotrexate
(rheumatology)
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Restricted Drug Restricted
Amber

Restricted: Initiated by consultant specialist only.

Extreme care must be taken when prescribing methotrexate:

  • Only 2.5mg tablets may be prescribed. Ensure total dose and quantity of tablets is clearly written on the prescription
  • The frequency must state once weekly (unless higher dosing is not tolerated, and the weekly dose can then be split into 3 doses per week).
  • Patients must be counselled to ensure they understand a once weekly regime. NPSA guidelines must be followed
 
   
Methotrexate (Metoject)
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Restricted Drug Restricted
Red

Injectable product not suitable for primary care prescribing unless shared care available from out of County provider

 

 
   
Rituximab (Truxima)
(Rheumatology - biosimilar)
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Restricted Drug Restricted
Red
High Cost Medicine

In line with NICE and local guidance [for oncology/haematology use see ch.8]

 
   
Rituximab (rheumatology) (MabThera)
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Restricted Drug Restricted
Red
High Cost Medicine

In line with NICE and local guidance [for oncology/haematology use see ch.8]

 
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
   
Tocilizumab (RoActemra)
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Restricted Drug Restricted
Red
High Cost Medicine

In line with NICE technology appraisals and local guidance

 
Link  NICE TA247:Tocilizumab in RA
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
   
10.01.03  Expand sub section  Cytokine modulators
10.01.03  Expand sub section  Sulfasalazine
Sulfasalazine
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Restricted Drug Restricted
Amber

Induction and maintenance of remission of ulcerative colitis; treatment of active Crohn's Disease.

 

Use EC tablets for rheumatoid arthritis

 
   
Sulfasalazine EC (Salazopyrin EN-Tabs)
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Restricted Drug Restricted
Amber

Can be supplied via a WVT PGD for authorised rheumatology clinical specialists (supply and monitor the use of sulfasalazine).

 
   
 ....
 Non Formulary Items
Anakinra  (Kineret)

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Non Formulary
High Cost Medicine
 
Auranofin  (Ridaura)

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Non Formulary
 
Methotrexate  (Ebetrex®)

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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
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

Traffic Light Status Information

Status Description

Green

Suitable for use in primary care  

Amber

Specialist initiation. Shared care in place  

Red

Red do not use..  

Advice

Some formulations restricted  

Black

NICE "Do not do"  

Green 1

1st line option  

Green 2

2nd line option  

Green 3

3rd line option only  

Not Recomended / Black

Low Value Medicine not recommended for use - see NHSE guidelines  

OTC

This preparation should be bought over the counter for self-care  

Red Amber

Check product description for traffic light status  

Red Black

Low Value Medicine  

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