netFormulary NHS
Buckinghamshire Formulary
Buckinghamshire Healthcare NHS Trust
Buckinghamshire CCG
 Search
 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
Chapter Links...
 Details...
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
10.01.03  Expand sub section  Gold
10.01.03  Expand sub section  Penicillamine
10.01.03  Expand sub section  Antimalarials
10.01.03  Expand sub section  Drugs affecting the immune response to top
Anakinra (Kineret®)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Red Specialist Centre
High Cost Medicine
Restricted - For treatment of JIA in accordance with NHS England Clinical Commissioning Policy Biologic Therapies for the treatment of Juvenile Idiopathic Arthritis (JIA) (July 2015) E03X04. Prescribing by consultant paediatric rheumatologist under 'shared care' with a Specialized Service Paediatric Rheumatology consultant in accordance with requirements defined in Policy E03X04. 
   
Azathioprine
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Protocol

See section 08.02.01

When prescribed by Rheumatology in accordance with Azathioprine for use in Rheumatology, Dermatology, Gastroenterology and Respiratory Medicine - Shared Care protocol (BHTCG 787FM)

 
Link  Azathioprine for use in Rheumatology, Dermatology, Gastroenterology and Respiratory medicine - Shared Care Protocol (BHTCG 787FM)
Link  Blood Monitoring Requirements for Amber Drugs - Primary/Secondary Care Guideline (BHTCG 821FM)
   
Ciclosporin
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Protocol

see Section 08.02.02
All products containing ciclosporin to be prescribed by brand name to minimise the risk of inadvertent switching between brands, and to reflect advice in the British National Formulary.
When prescribed by Rheumatology in accordance with Shared Care protocol (BHTCG 788FM)

 
Link  Blood Monitoring Requirements for Amber Drugs - Primary/Secondary Care Guideline (BHTCG 821FM)
Link  Ciclosporin for use in Dermatology, Gastroenterology and Rheumatology - Shared Care Protocol (BHTCG 788FM)
   
Leflunomide 10mg, 20mg, 100mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Protocol

Restricted - to initiation by Consultant Rheumatologists in accordance with Leflunomide for use in Rheumatology Shared Care protocol (BHTCG 790FM).

 
Link  Leflunomide for use in Rheumatology - Shared Care Protocol (BHTCG 790FM)
Link  MHRA advice regarding risk of hepatotoxicity, haemotoxicity, infections, and birth defects
Link  Blood Monitoring Requirements for Amber Drugs - Primary/Secondary Care Guideline (BHTCG 821FM)
   
Cytotoxic Drug Methotrexate 2.5mg
(tablet)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Protocol

When prescribed by Rheumatology in accordance with Methotrexate for use in Rheumatology, Dermatology, Gastroenterology and Respiratory Medicine Shared Care protocol (BHTCG 794FM)

 
Link  Methotrexate for use in Rheumatology, Dermatology, Gastroenterology and Respiratory medicine - Shared Care Protocol (BHTCG 794FM)
Link  Blood Monitoring Requirements for Amber Drugs - Primary/Secondary Care Guideline (BHTCG 821FM)
   
Cytotoxic Drug Methotrexate 50mg/mL (7.5mg, 10mg, 12.5mg, 15mg, 17.5mg, 20mg, 22.5mg, 25mg, 27.5mg, 30mg doses) (Metoject® PEN)
(injection, prefilled injection device)
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted
Amber Protocol

Restricted - prescribing by Consultant Rheumatologists and Dermatologists only, in accordance with Methotrexate for use in Rheumatology, Dermatology, Gastroenterology and Respiratory Medicine Shared Care protocol (BHTCG 794FM) for patients on oral methotrexate, with severe GI side effects despite regular folic acid (5mg, 6 days a week) or non-responders to oral therapy after an 8-12 week trial, in order to improve bioavailability.

 
Link  Methotrexate for use in Rheumatology, Dermatology, Gastroenterology and Respiratory medicine - Shared Care Protocol (BHTCG 794FM)
Link  Blood Monitoring Requirements for Amber Drugs - Primary/Secondary Care Guideline (BHTCG 821FM)
   
10.01.03  Expand sub section  Cytokine modulators
10.01.03  Expand sub section  Sulfasalazine
 ....
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

Black

Not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.
Drugs which have been evaluated and rejected by the Medicines Value Group (MVG)
Drugs defined as ‘Low Priority’ by the South Central Priorities Committee
New drugs which have not as yet been evaluated by the MVG
Any drug not listed in the Buckinghamshire Formulary  

Red

Drugs which should only be prescribed in secondary care by a specialist.
Require specialist knowledge and/or equipment for patient selection and initiation
Require long term on-going monitoring and dose adjustment to ensure efficacy and minimise toxicity by a specialist
Designated as “hospital only“ by product licence, NICE, DoH or BNF
May need further evaluation by a specialist
Are hospital initiated clinical trial materials  

Red Specialist Centre

As for ‘red’ (above) with the addition of the following:
Designated by NHS England to require initiation by or in prior agreement with a Specialist Centre. Continuation where appropriate by BHT (or other secondary care provider)
Detailed requirements for Specialist Centre initiation to be described in the wording of the formulary restriction  

Amber Protocol

Drugs which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a drug specific Shared Care Protocol(SCP). Prescribing may be continued in primary care following the SCP
Require specialist knowledge and/or equipment for patient selection and initiation
Require short or medium term (eg. 3 to 6 months) specialist monitoring of efficacy or toxicity. The need for stabilisation will vary with different drugs and patients, but is usually a minimum of 2 months (see principles for shared care)
Require significant long term monitoring
Require ongoing communication between the GP and the specialist
Have clearly defined consultant, GP and patient responsibilities documented in a shared care protocol (see responsibilities for amber protocol drugs)  

Amber Initiation

Drugs suitable for primary care prescribing following specialist initiation
Require specialist knowledge and/or equipment for patient selection
Monitoring does not require specialist knowledge or equipment
If the drug is one with which the primary care prescriber is unfamiliar the specialist is expected to provide sufficient information on the drug indication, dose, duration , monitoring and any further necessary dose adjustments
Require the first prescription to be written by the specialist  

Amber Recommended

Drugs suitable for primary care prescribing following specialist recommendation
As for amber initiation except that:- The first prescription may be written by the GP after specialist recommendation.  

Green

Drugs for which primary care prescribers would normally take full responsibility for prescribing and monitoring
Drugs not included in the Traffic Light list but included on joint formulary.
New drugs classified as red or amber but as greater experience regarding their safety and efficacy is established may move to Green after re-consideration by the MVG and APC.  

netFormulary