10 Musculoskeletal and Joint Diseases
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1 10 Musculoskeletal and Joint Diseases To be used in conjunction with NICE guidance, The British National Formulary for adults and/or children and British Society of Rheumatology guidelines and guidance Index 10.1 Drugs used in rheumatic diseases and gout 10.2 Drugs used in neuromuscular disorders 10.3 Drugs for the treatment of soft-tissue disorders & topical pain relief
2 10.1 Drugs used in rheumatic diseases and gout NICE guidance on the management of rheumatoid arthritis in adults (CG79) DRUG BRAND / FORMULATION NOTES Sodium Hyaluronate Ostenil Plus 40mg in 2ml injection Specialist use only Non-steroidal Anti-inflammatories (see trust MMG024) Celecoxib 100mg capsules x mg capsules x 30 Diclofenac 25mg & 50mg EC tablets x 28 50mg Dispersible tablets x 30 75mg SR tablets x mg SR tablets x mg, 25mg, 50mg & 100mg suppositories x 10 75mg/3mL ampoules x 1 / 10 Restricted use use only if patient intolerant to NSAID + PPI See MMG024 Ibuprofen 1 st line Etoricoxib 30mg, 60mg & 90mg tablets x 28 Restricted use use only if patient intolerant to NSAID + PPI
3 Ibuprofen 200mg tablets x 24 / mg tablets x 24 / mg/5mL Syrup (SF) x 100ml / 150ml 1 st line NSAID Indometacin Indometacin 25mg capsules x 28 Specialist use only Mefenamic Acid Mefenamic Acid 500mg tablets x 28 Use in Gynaecology only Naproxen 250mg tablets x mg & 500mg EC tablets x mg/5mL Suspension x 500mL See MMG024 Ibuprofen first line Parecoxib 40mg Injection (vial) x 5 / 10 For peri-operative use only Corticosteroids Local corticosteroid injections Hydrocortistab Hydrocortisone acetate 25mg/1mL Injection x 10 Depo-Medrone Methylprednisolone acetate 40mg/1mL Injection x 10 Methylprednisolone acetate 80mg/2mL Injection x 10 Methylprednisolone acetate 120mg/4mL Injection x 10 Depo-Medrone with Lidocaine Methylprednisolone 40mg & Lidocaine 10mg in 1mL Injection x 10 Methylprednisolone 80mg & Lidocaine 20mg in 2mL Injection x 10 Adcortyl: Triamcinolone acetonide 10mg/1mL Injection x 5
4 Drugs that suppress the rheumatic disease process Kenalog: Triamcinolone acetonide 40mg/1mL Injection x 5 Triamcinolone hexacetonide 20mg/1mL Injection x 1 Gold Sodium aurothiomalate 10mg/0.5mL Injection x 10 Sodium aurothiomalate 50mg/0.5mL Injection x 10 Penicillamine 250mg tablets x 56 / 100 Antimalarials Hydroxychloroquine Sulphate 200mg tablets x 60 Drugs affecting the immune response Azathioprine See Section Ciclosporin See Section Leflunomide 10mg & 20mg tablets x 30 Methotrexate 2.5mg tablets x 24 Pre-filled syringe 5mg/0.2mL (Metoject) Pre-filled syringe: 7.5mg/0.15mL 10mg/0.2mL 12.5mg/0.25mL 15mg/0.3mL 17.5mg/0.35mL 20mg/0.4mL 22.5mg/0.45mL 25mg/0.5mL Once a week use only
5 Cytokine Modulators Adalimumab 40mg prefilled pen & syringe Homecare Anakinra 100mg prefilled syringe Homecare Certolizumab Pegol 200mg prefilled syringe Homecare Etanercept 25mg prefilled syringe & vial Homecare 50mg prefilled syringe & pen Golimumab 50mg & 100mg prefilled syringe & pen Homecare Infliximab 100mg vial Homecare Rituximab See Section Tocilizumab 80mg, 200mg & 400mg vial Homecare Sulfasalazine 500mg e/c tablets x 112 See Chapter 1 for non e/c use in IBD Gout and cytotoxic-induced hyperuricaemia Acute attacks of gout Colchicine 500mcg tablets x 100 Long-term control of gout Allopurinol 100mg & 300mg tablets x 28 Benzbromarone 100mg tablets x 30 / 100 Unlicensed restricted use
6 Febuxostat 80mg & 120mg f/c tablets x 28 See NICE guidance not 1 st line Probenecid 500mg tablets x 50 / 100 Unlicensed Hyperuricaemia associated with cytotoxic drugs Rasburicase 7.5mg injection vial Return to index
7 10.2 Drugs used in neuromuscular disorders Drugs that enhance neuromuscular transmission Edrophonium Chloride 10mg in 1ml injection x 10 Neostigmine 2.5mg in 1ml injection x 10 Methylsulphate Pyridostigmine Bromide 60mg tablets x 200 Skeletal muscle relaxants Baclofen 10mg tablets x 84 5mg in 5ml liquid x 300ml Intrathecal injection available on named patient basis via pharmacy technical services unit (contact main dispensary) Dantrolene 25mg & 100mg capsules x 100 Diazepam See Section Tizanidine 2mg & 4mg tablets x 120 Nocturnal leg cramps Quinine Sulphate See Section Only use if cramps cause regular disruption to sleep
8 Return to index
9 10.3 Drugs used for the treatment of soft-tissue disorders and topical pain relief Enzymes Hyaluronidase 1500unit ampoule x 10 Rubefacients, topical NSAIDs, capsaicin, and poultices Rubefacients Deep Heat rub Movelat 35g ointment 125g cream & gel Topical NSAIDs Benzydamine Hydrochloride Ibuprofen 3% cream 100g 5% gel 100g Capsaicin Axsain 0.075% cream 45g Licensed for neuropathic pain Zacin 0.025% cream 45g Licensed for osteoarthritis
10 Poultices Kaolin 100g sachet Other topical preparations Paraffin Wax Low Melting Point (43-46) 2kg pack Used by physiotherapy Return to index
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