North East and North Cumbria Formulary


	North East and North Cumbria ICS Formulary

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Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter

10.02

Drugs used in neuromuscular disorders

Mexiletine (Namuscla^®)

Formulary

Approved for the treatment of myotonia in patients with non-dystrophic myotonic disorders in line with NICE and NHSE commissioning policy (SSC2001).

NICE TA748: Mexiletine for treating the symptoms of myotonia in non-dystrophic myotonic disorders

Nusinersen (Spinraza^®)

Formulary

12mg solution for injection

Approved as an option for treating 5q spinal muscular atrophy (SMA) types 1, 2 or 3 in line with NICE.

NHS England Urgent Clinical Commissioning Policy Statement (170018/P)

NICE TA588: Nusinersen for treating spinal muscular atrophy

Risdiplam

(Evrysdi^®)

Formulary

0.75mg/1ml oral solution
Approved for treating spinal muscular atrophy in line with NICE
To be provided by Newcastle Hospitals homecare service only

NICE TA755: Risdiplam for treating spinal muscular atrophy

10.02.01

Drugs used in neuromuscular disorders

Ataluren (Translarna®)

Formulary

Approved as an option for treating Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene in people 2 years and over who can walk - in line with NICE HST22.

NICE HST22: Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene

10.02.01

Anticholinesterases

Edrophonium Chloride

Formulary

Neostigmine

Formulary

2.5mg in 1ml injection

Pyridostigmine Bromide

Formulary

10.02.01

Immunosuppressant therapy

10.02.01

Acetylcholine-release enhancers

10.02.02

Skeletal muscle relaxants

Baclofen
(Tablets, SF liquid & injection)

First Choice

The following baclofen intrachecal injections (unlicensed) are also approved; 36mg in 12ml, and 72mg in 12ml intrathecal injections.

Diazepam
(Tablets, solution, syrup, injection)

First Choice

Note: diazepam 10mg tablets are no longer on the formulary.

Cannabis extract (Sativex^®)

Formulary

cannabidiol 2.5mg/dronabinol 2.7mg per dose oromucosal spray
approved to treat moderate to severe spasticity in adults with multiple sclerosis in line with NICE

NENC Shared Care Protocol: Sativex (delta-9-tetrahydrocannabinol / cannabidiol) Oromucosal Spray

NICE NG144: Cannabis-based medicinal products

Dantrolene
(Capsules)

Alternatives

Tizanidine

Alternatives

Approved for use on advice from neurologists when other treatments are unsuitable.

10.02.02

Other muscle relaxants

10.02.02

Nocturnal leg cramps

Quinine sulfate

Formulary

200mg & 300mg tablets
Approved for nocturnal leg cramps in accordance with MHRA advice

....

Non Formulary Items

Ravulizumab (Ultomiris^®)

Non Formulary

300mg/30ml and 110mg/11ml concentrate for solution for infusion
Not recommended for treating generalised myasthenia gravis in adults in line with NICE
Not recommended for treating AQP4 antibody-positive neuromyelitis optica spectrum disorder in adults in line with NICE

NICE TA940: Ravulizumab for treating generalised myasthenia gravis (terminated appraisal)

NICE TA941: Ravulizumab for treating AQP4 antibody-positive neuromyelitis optica spectrum disorder (terminated appraisal)

Satralizumab (Enspryng^®)

Non Formulary

Not recommended for preventing relapses in neuromyelitis optica spectrum disorder in line with NICE

NICE TA960: Satralizumab for preventing relapses in neuromyelitis optica spectrum disorders

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.
	Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.
	Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.
	Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.
	NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.
	UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.
	NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.