netFormulary The Pennine Acute Hospitals NHS
NHS Trust Formulary  
 Search
 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01  Drugs used in rheumatic diseases and gout
10.01  Rheumatoid arthritis and other inflammatory disorders
10.01  Osteoarthritis and soft-tissue disorders
Hyaluronic acid
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Restricted Item See link 
Link  Greater Manchester Policy Statement NWCSU June 2014: Hyaluronic Acid Injections for Osteoarthritis (GM037)
   
Hylan G-F 20 (Synvisc®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Restricted Item See link 
Link  Greater Manchester Policy Statement NWCSU June 2014: Hyaluronic Acid Injections for Osteoarthritis (GM037)
   
10.01.01  Non-steroidal anti-inflammatory drugs
Ibuprofen
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets
Oral suspension
5% gel 
Naproxen
View adult BNF View SPC online View childrens BNF  Track Changes
Second Choice Tablets 
   
Etoricoxib (Arcoxia®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
Link  MHRA Safety Update: Revised dosing recommendations
   
Celecoxib (Celebrex®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules 
   
Diclofenac
View adult BNF View SPC online View childrens BNF  Track Changes
Restricted Drug Restricted Suppositories
Injection


Restricted Item 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)

Diclofenac treatment should only be initiated after careful consideration for patients with significant risk factors for cardiovascular events (eg, hypertension, hyperlipidaemia, diabetes mellitus, smoking).

 
Link  MHRA Drug Safety Update: Diclofenac contraindications and warnings
   
Etodolac
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Modified release tablets 
   
Indometacin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Modified-release capsules
Suppositories
 
   
Mefenamic Acid
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules
Tablets
Oral suspension 
   
Meloxicam
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
   
Nabumetone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral suspension 
   
10.01.02  Corticosteroids to top
10.01.02.01  Systemic corticosteroids
10.01.02.02  Local corticosteroids injections
Methylprednisolone Acetate (Depo-Medrone®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Injection 
Methylprednisolone Acetate (Depo-Medrone® with Lidocaine)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Injection 
Dexamethasone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
Link  MHRA Drug Safety Update October 2014: Dexamethasone injection reformulation with changes in name, conc, storage conditions and presentation
   
Hydrocortisone acetate (Hydrocortistab®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 25mg/ml intra-articular injection 
   
Triamcinolone Acetonide
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
10.01.03  Drugs which suppress the rheumatic disease process
10.01.03  Gold
Sodium Aurothomalate (Myocrisin®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Injection 
   
10.01.03  Penicillamine to top
Penicillamine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Tablets 
   
10.01.03  Antimalarials
Hydroxychloroquine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Tablets 
   
10.01.03  Drugs affecting the immune response
Apremilast (Otezla® )
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Tablets 
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
   
Cytotoxic Drug Azathioprine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Tablets 
   
Baricitinib (Olumiant®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine

Tablets

 
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
   
Ciclosporin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Capsules

Prescribe by brand
 
   
Cytotoxic Drug Cyclophosphamide
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Tablets
Injection 
   
Leflunomide
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Tablets

Restricted Item Specialist Initiation Only 
   
Cytotoxic Drug Methotrexate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Tablets
Pre-filled injection pen (supplied to patients via homecare arrangements)

Restricted Item Specialist initiation only

WEEKLY dosing
 
Link  NPSA Alert, June 2006: Improving compliance with oral methotrexate guidelines
   
Mycophenolate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Tablets
Capsules


unlicensedunlicensed indication (rheumatoid arthritis).  
Link  MHRA Safety Alert: Contraception advice for male patients
Link  MHRA Safety Update: Pregnancy prevention advice
   
Tofacitinib (Xeljanz)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
BlueTeq

Tablets

 
Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
   
10.01.03  Biologics
 note  Biologics can be used, without prior funding approval, according to GMMMG-approved pathways: Harmonised Biologics Pathway for Rheumatoid Arthritis and Harmonised Biologics Pathway for Ankylosing Spondylitis and Psoriatic Arthritis
Abatacept
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Homecare

Intravenous infusion

 
   
Adalimumab  (Amgevita®) (BIOSIMILAR)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Homecare
BlueTeq

Subcutaneous Injection

 
   
Adalimumab (Humira®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Homecare
BlueTeq

Subcutaneous Injection

 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
   
Certolizumab Pegol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Homecare

Subcutaneous Injection

 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
Link  NICE TA375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
   
Etanercept (Benepali® )
(BIOSIMILAR)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Homecare

Subcutaneous Injection



  • New patients only

 
Link  GMMMG Guidance: Prescribing Biosimilar Biologic Medicines
Link  GMMMG Recommendation: Etanercept biosimilar (Benepali)
Link  UKMi Q&A: What are biosimilar medicinal products?
   
Etanercept (Enbrel®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Homecare

Subcutaneous Injection



 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab
Link  NICE TA35: Arthritis (juvenile idiopathic) - etanercept
   
Golimumab
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Homecare

Subcutaneous Injection

 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
Link  NICE TA220: Psoriatic arthritis - golimumab
Link  NICE TA225: Rheumatoid arthritis - golimumab
Link  NICE TA233: Ankylosing spondylitis - golimumab
   
Infliximab
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Intravenous Infusion 
Link  MHRA Drug Safety Update, April 2014: TNF alpha inhibitors: Risk of tuberculosis - screen all patients before starting treatment and monitor them closely.
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab
   
Rituximab
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Intravenous Infusion 
Link  MHRA Drug Safety Update December 2009: Rituximab: progressive multifocal leukoencephalopathy in a patient without prior treatment for RA
Link  MHRA Drug Safety Update, December 2013: Rituximab: screen for hepatitis B virus before treatment
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
   
Sarilumab (Kavzara®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red

Pre-filled syringe or pen

 
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
   
Secukinumab (Cosentyx®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Homecare

Pre-filled syringe

 
Link  NICE TA445: Secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
   
Tocilizumab
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Intravenous preparation ONLY

(Subcutaneous preparation is currently non-formulary) 
Link  NICE TA198: Rheumatoid arthritis - tocilizumab
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
   
Ustekinumab
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Homecare

Subcutaneous Injection


Approved for use as per NICE TA340, i.e.:

Ustekinumab is recommended as an option, alone or in combination with methotrexate, for treating active psoriatic arthritis in adults only when:
• treatment with TNF alpha inhibitors is contraindicated but would otherwise be considered (as described in NICE guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis and golimumab for the treatment of psoriatic arthritis)
• or the person has had treatment with 1 or more TNF–alpha inhibitors.

Ustekinumab is recommended only if the company provides the 90mg dose of ustekinumab for people who weigh more than 100 kg at the same cost as the 45mg dose, as agreed in the patient access scheme.

 
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
   
10.01.03  Sulfasalazine
Sulfasalazine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Enteric coated tablets 
   
10.01.04  Gout and cytotoxic-induced hyperuricaemia to top
10.01.04  Acute attacks of gout
Colchicine
(Alternative where NSAIDs contraindicated)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
Link  British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout
Link  MHRA Drug Safety Update, November 2009: Colchicine, extremely toxic in overdose
   
10.01.04  Long-term control of gout
Allopurinol
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets 
Febuxostat (Adenuric® )
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green 3
Tablets


 
Link  NICE TA164: Febuxostat for the management of hyperuricaemia in people with gout
Link  MHRA Drug Safety Update, June 2012: Febuxostat: Serious hypersensitivity reactions
   
Benzbromarone
View adult BNF View childrens BNF  Track Changes
Formulary

Tablets

unlicensed unlicensed

 
   
Sulfinpyrazone
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
 
   
Probenecid
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

unlicensedunlicensed
 
   
10.01.04  Hyperuricaemia associated with cytotoxic drugs
Rasburicase (Fastertec®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Intravenous infusion 
   
10.01.05  Other drugs for rheumatic diseases
10.02  Drugs used in neuromuscular disorders to top
10.02.01  Drugs which enhance neuromuscular transmission
10.02.01  Anticholinesterases
Pyridostigmine Bromide
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets 
Neostigmine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Injection (see chapter 15) 
Link  UKMI Q&A: Converting between Pyridostigmine & Neostigmine
   
10.02.01  Immunosuppressant therapy
10.02.01  Acetylcholine-release enhancers
10.02.02  Skeletal muscle relaxants to top
Dantrolene
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Capsules 
Diazepam
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral solution 
   
Baclofen
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Oral solution 
   
Tizanidine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green 3
Tablets 
   
10.02.02  Other muscle relaxants
10.02.02  Nocturnal leg cramps
Quinine Sulphate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
   
10.03  Drugs for the treatment of soft-tissue disorders and topical pain relief
10.03.01  Enzymes
Collagenase (Xiapex®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
Intralesional injection

Individual funding request is NOT required when used for Dupytren's contracture that is moderate in nature. Defined as:

  • Notable functional problems,
    AND one of the following:
  • Moderate metacarpo-phalangeal joint contracture (30° – 60°)
    OR
  • Moderate proximal inter-phalangeal joint contracture (<30°)
    OR
    First web contracture.

    For all other indications (e.g. Frozen Shoulder / Peyronie's Disease / any other use / non-moderate Dupytren's) an individual funding request is required.  
  •    
    Hyaluronidase
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Injection 
       
    10.03.02  Rubefacients, topical NSAIDs, capsaicin, and poultices to top
    10.03.02  Topical NSAIDs and counter-irritants
    Ibuprofen gel
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice Gel 
    Ketoprofen gel
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Gel 
    Link  MHRA Drug Safety Update, August 2010: Topical ketoprofen: reminder on risk of photo-sensitivity reactions
    Link  MHRA Drug Safety Update, June 2009: Topical ketoprofen: reminder on risk of photo-sensitivity reactions
       
    Piroxicam gel
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Gel 
       
    10.03.02  Capsaicin
    Capsaicin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary 0.025% cream (adjunct in hand or knee osteoarthritis)
    0.075% cream (postherpetic neuralgia and diabetic neuropathy)
     
    Link  GMMMG Neuropathic Pain Guidance
    Link  NICE CG177: Osteoarthritis
       
    10.03.02  Rubefacients
     note  The evidence available does not support the use of topical rubefacients in acute or chronic musculoskeletal pain.
    Transvasin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary Heat rub cream 
       
     ....
     Non Formulary Items
    Acelofenac  (Preservex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Acemetacin  (Emflex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Amifampridine

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
     
    Anakinra

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Red
     
    Auranofin  (Ridaura®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Azapropazone  (Rheumox®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Belimumab

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Red
    GMMMG recommends that belimumab may be used only when commissioned by NHS England
     
    Betamethasone  (Betnesol®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary Not on GMMMG formulary for musculoskeletal indications
     
    Controlled Drug  Cannabis extract  (Sativex®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary


    Red Traffic Light  Red for unlicensed indications

    Link  GMMMG NTS Recommendation: Sativex for MS
    Link  GMMMG NTS Recommendation: Sativex for non-MS pain (unlicensed)
     
    Chloroquine

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
     
    Dexibuprofen  (Seractil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dexketoprofen  (Keral®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Diclofenac

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary Tablets
    Dispersible tablets
    Modified-Release Capsules/Tablets

    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)
    Patients with these conditions should be switched to an alternative treatment at their next routine appointment.

    Link  MHRA Drug Safety Update June 2013: Diclofenac Cardiovascular Safety
    Link  MHRA Drug Safety Update October 2012: Diclofenac Cardiovascular Risk
     
    Diclofenac gel

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary Gel

    Can be used for established patients only.
     
    Diclofenac with Misoprostol  (Arthrotec 50 and 75®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary Tablets
    Link  MHRA Drug Safety Update June 2013: Diclofenac Cardiovascular Safety
    Link  MHRA Drug Safety Update October 2012: Diclofenac Cardiovascular Risk
     
    Diethylamine salicylate  (Algesal)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary

    Cream

     
    Distigmine Bromide

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary DISCONTINUED
     
    Edrophonium Chloride

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary DISCONTINUED
     
    Fampridine

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
     
    Felbinac  (Traxam®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fenbufen

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Fenoprofen  (Fenopron®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Flurbiprofen

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Glucosamine

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    Not NHS Not NHS

    Link  GMMMG Do Not Prescribe list
    Link  NICE CG177: ’Do not offer glucosamine or chondroitin products for the management of osteoarthritis’
    Link  UKMI Q&A: Glucosamine - drug interactions
    Link  UKMI Q&A: Glucosamine - what are the adverse effects?
    Link  UKMI Q&A: Glucosamine in renally impaired patients
     
    Ibuprofen and famotidine  (Duexis®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Kaolin Poultice

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Kaolin Poultice  (Kaolin Poultice K/L Pack®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ketoprofen

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lumiracoxib  (Prexige®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Methocarbamol  (Robaxin®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary May be prescribed for established patients.
     
    Naproxen & esomeprazole  (Vimovo®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Naproxen with Misoprostol  (Napratec®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Piroxicam

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Link  CHMP advice June 2007: Restricted use of piroxicam
     
    Prednisolone Acetate  (Deltastab®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary Not on GMMMG formulary for musculoskeletal indications.
     
    Sulindac

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
     
    Tenoxicam  (Mobiflex®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tiaprofenic Acid

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
     
    Tocilizumab

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Red
    Subcutaneous injection

    Supplied via homecare arrangements

     
      
    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

    Amber

    Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

    Black

    These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

    Green

    Not used   

    Green 1

    Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

    Green 2

    Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

    Green 3

    Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

    Grey

    Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

    Red

    Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

    netFormulary