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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01.01  Expand sub section  Non-steroidal anti-inflammatory drugs
Ibuprofen
(Oral)
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Restricted Drug Restricted
Brown

First line NSAID. 

Available to purchase over the counter for short-term use. 

Only prescribe if more than 28 tablets per month are required for an ongoing basis for a chronic condition, in line with Clinical Commissioning Policy 88D.

 
Naproxen
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Second Choice
Green

May have a lower cardiovascular risk than other NSAIDs and COX2's. Good alternative if ibuprofen is not suitable.

 
   
Mefenamic Acid
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Formulary
Green

Prescribe generically. 

Tablets are more cost-effective than capsules.

 
Link  CKS Review of Evidence: Drugs to treat menorrhagia
   
Indometacin
(Oral)
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Formulary
Green
 
   
Piroxicam
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Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist initiation by rheumatologist.

The MHRA (2007) has recommended restrictions on the use of piroxicam because of the increased risk of gastro-intestinal side effects and serious skin reactions. Piroxicam should be initiated only by specialists as a second-line treatment for arthritis.

 
Link  MHRA: New restrictions including specialist initiation
   
Diclofenac Sodium
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Restricted Drug Restricted
Brown

MHRA 2013: Diclofenac is contraindicated in patients with established:

  • Ischaemic heart disease
  • Peripheral arterial disease
  • Cerebrovascular disease
  • Congestive heart failure (New York Heart Association [NYHA] classification II–IV)

 
Link  MHRA: Contraindications and warnings due to CV risk
Link  MHRA: patient information on CV risk
Link  EMA: Diclofenac and CV risk review compared to ibuprofen and naproxen
   
Celecoxib
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Restricted Drug Restricted
Brown

For use in osteoarthritis and rheumatoid arthritis as per NICE guidelines only.

Onsenal® was withdrawn from the market in August 2011.

 
   
Etoricoxib (Arcoxia®)
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Restricted Drug Restricted
Brown

For use in osteoarthritis and rheumatoid arthritis as per NICE guidelines only.

 
   
Flurbiprofen
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Restricted Drug Restricted
Brown

Restricted for use in Palliative Care only.

 
   
Ibuprofen (Brufen Retard®)
(Modified-release tablets)
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Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation by rheumatologist.

 
   
Nabumetone
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Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation by rheumatologist.

 
   
Sulindac
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Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation from Maternity and Gynaecology only.

 
   
Etodolac
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Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist recommendation by rheumatologist.

 
   
Meloxicam
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Formulary
Amber Continuation

Suitable for prescribing in primary care following specialist initiation by rheumatologist.

 
   
10.01.01  Expand sub section  Aspirin
 ....
 Non Formulary Items
Acelofenac

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Non Formulary
Link  MHRA: Updated cardiovascular advice for aceclofenac
 
Acemetacin  (Emflex®)

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Non Formulary
 
Azapropazone  (Rheumox®)

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Non Formulary
 
Dexibuprofen  (Seractil®)

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Non Formulary

No advantage over parent drug ibuprofen.

 
Dexketoprofen  (Keral®)

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Non Formulary

No advantage over parent drug ketoprofen.

 
Diclofenac Potassium

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Non Formulary
 
Diclofenac Sodium
(Modified-release)

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Non Formulary
 
Diclofenac with Misoprostol  (Arthrotec®)

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Non Formulary
Black

Not recommended for use. 

APCO January 2014. 

 
Diclofenac with Misoprostol  (Misofen®)

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Non Formulary
Black

APCO January 2014.

 
Fenbufen  (Lederfen®)

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Non Formulary
 
Fenoprofen  (Fenopron®)

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Non Formulary
 
Ibuprofen and famotidine  (Duexis®)

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Non Formulary
 
Ketoprofen
(Oral)

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Non Formulary
 
Naproxen and Esomeprazole  (Vimovo®)

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Non Formulary
Black

Not recommended for use.

APCO January 2012.

 
Naproxen with Misoprostol  (Napratec®)

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Non Formulary
 
Tenoxicam

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Non Formulary
 
Tiaprofenic Acid

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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
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Link to adult BNF
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Link to children's BNF
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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

Red

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred.   

Amber Shared Care Protocol

Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO).   

Green

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

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