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Southampton Joint Formulary
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.02  Expand sub section  Drugs used in neuromuscular disorders
AtalurenBlack Triangle (Translarna®)
(granules)
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Red Specialist Centre
High Cost Medicine
NHS England
BlueTeq

For use in line with NHSE specialised commissioning criteria

 
Link  NICE HST3: Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene
   
Cladribine (Mavenclad®)
(tablets)
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Red
High Cost Medicine
NHS England
 
Link  NICE TA616: Cladribine for treating relapsing–remitting multiple sclerosis
   
NusinersenBlack Triangle (Spinraza ®)
(injection)
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Red
High Cost Medicine
NHS England
BlueTeq

For use in spinal muscular atrophy (SMA) in line with NHSE specialised commissioning criteria

 

 
Link  Clinical Commissioning Policy Statement: Nusinersen for genetically confirmed Spinal Muscular Atrophy (SMA) type 1 for eligible patients under the Expanded Access Programme (EAP)
Link  NICE TA588: Nusinersen for treating spinal muscular atrophy
   
10.02.01  Expand sub section  Drugs which enhance neuromuscular transmission
10.02.01  Expand sub section  Anticholinesterases
Neostigmine
(tablet/injection)
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Red
 
   
Pyridostigmine Bromide
(tablet)
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Amber Initiation
 
   
10.02.01  Expand sub section  Acetylcholine-release enhancers
Amifampridine base (3,4-diaminopyridine)
(tablet)
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Red
High Cost Medicine

unlicensed unlicensed

For Lambert-Eaton myasthenic Syndrome

 
   
10.02.02  Expand sub section  Skeletal muscle relaxants to top
Baclofen
(tablet/liquid)
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Green
 
   
Controlled Drug Cannabis extract (Sativex®)
(oromucosal spray)
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Red

Restricted Item Restricted use.

Use is supported only for spasticity in patients with multiple sclerosis in accordance with NICE guidelines NG144.

Must be initiated and supervised by a physician with specialist expertise in treating spasticity due to multiple sclerosis.

For secondary care prescribing only until shared care guidelines have been developed and approved.

 
Link  NICE Guidelines NG144 Cannabis-based medicinal products Nov 2019
Link  SHIP8 Priorities Committee Policy Recommendation: Sativex for symptom improvement in adult patients with moderate to severe spasticity due to multiple sclerosis
   
Dantrolene
(capsule)
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Green
 
   
Diazepam
(tablet/liquid/injection/rectal liquid)
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Green
 
   
Mexiletine (Namuscla®)
(capsules - myotonia)
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Red Specialist Centre
High Cost Medicine
NHS England
BlueTeq

 Commissioned by NHS England for patients with non-dystrophic myotonia within specialised neurosciences centres only

note Note: mexiletine also approved locally as amber for cardiology use only (see section 2.3.2).

(167mg mexiletine = 200mg mexiletine hydrochloride)

 
Link  NHS England Letter confirming commissioning arrangements for NaMuscla April 2019
   
Tizanidine
(tablet)
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Amber Recommended
 
   
10.02.02  Expand sub section  Other muscle relaxants
10.02.02  Expand sub section  Nocturnal leg cramps
Quinine sulfate
(tablet)
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Green
 
   
 ....
 Non Formulary Items
Distigmine Bromide

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Non Formulary
 
Edrophonium Chloride

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Non Formulary
 
Methocarbamol  (Robaxin®)

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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
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine

Traffic Light Status Information

Status Description

Green

Suitable for prescribing by all in both primary and secondary care.  

Amber Recommended

Specialist recommended but suitable for continuation in primary care.  

Amber Initiation

Specialist initiated but suitable for continuation in primary care.  

Amber SCG

Specialist initiated and for continuation in primary care under a locally approved shared care guideline.  

Red

Suitable for prescribing in specialist settings (secondary care) only.   

Red Specialist Centre

Secondary care medicines to be used under specialised commissioning arrangements only.  

Blue

For primary care, either via FP10 or supplied through specialist services. These products may be stocked by hospital pharmacies only for supply to primary care units/wards or for continuing supplies for patients admitted on therapy.  

Black

Not recommended for use.  

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