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Musculoskeletal system
Musculoskeletal system / Pain and inflammation in musculoskeletal disorders
  aspirin Off Formulary
  diclofenac potassium Off Formulary
  diclofenac sodium On Formulary
The Association of Paediatric Palliative Medicine Formulary - 2017

see attached
Guidelines for treating acute pain in paediatric in-patients 2018

see attached
  etoricoxib Off Formulary
The Association of Paediatric Palliative Medicine Formulary - 2015

  flurbiprofen Off Formulary
  ibuprofen On Formulary
Guidelines for treating acute pain in paediatric in-patients February 2018

Oxycodone PCA is also approved for acute pain use at RLH.
It is reserved for use after morphine, fentanyl or ketamine combinations have been tried.
Patient Criteria:
1st line – morphine+/- ketamine
2nd line – fentanyl +/- ketamine
3rd line - oxycodone
Duration: approximately 2 weeks
Administration details
Oxycodone 1mg/kg up to 50mg made up to 50mL sodium chloride 0.9%
Bart's Health Clinical Practice Policy on Intravenous PCA/NCA for Paediatric Patients in Acute Pain

see attached
The Association of Paediatric Palliative Medicine Formulary - 2015

see attached
  meloxicam Off Formulary
  naproxen On Formulary
  piroxicam Off Formulary
Musculoskeletal system / Arthritis
  abatacept Off Formulary NICE TA373
ABATACEPT

Hospital Only Drug

Abatacept would normally be supplied by GOSH (or other tertiary shared care centre for paediatric rheumatology).

Morphea

Abatacept for treatment of severe treatment-resistant morphoea (localised scleroderma) (adults and children 2 years and over) (210505P) [1921]

Approved in October 2021 DTC- as per NHSE commissioning policy statement (Hospital Only)
  adalimumab On Formulary NICE TA373
NICE TA455
ADALIMUMAB

Hospital Only Drug

Adalimumab would normally be supplied by GOSH (or other tertiary shared care centre for paediatric rheumatology).

  Solution for injection
Humira (AbbVie Ltd) On Formulary
Humira®

Hospital Only Drug

Adalimumab would normally be supplied by GOSH (or other tertiary shared care centre for paediatric rheumatology).

  anakinra Off Formulary NICE TA685
  azathioprine Off Formulary
Difficult to Obtain Letter

see attached
Cystic Fibrosis & non-CF Prescribing Pathway

see attached
  chloroquine Hospital Only
  Oral solution
Malarivon (Wallace Manufacturing Chemists Ltd) Hospital Only
  cyclophosphamide On Formulary
  diclofenac potassium Off Formulary
  diclofenac sodium On Formulary
The Association of Paediatric Palliative Medicine Formulary - 2017

see attached
Guidelines for treating acute pain in paediatric in-patients 2018

see attached
  etanercept Hospital Only NICE TA455
NICE TA373
ETANERCEPT

Hospital Only Drug
NICE Guidance - Etanercept for the treatment of Juvenile Idiopathic Arthritis

see attached - usually supplied by GOSH
  Solution for injection
Benepali (Biogen Idec Ltd) Hospital Only
Enbrel (Pfizer Ltd) Hospital Only
Enbrel®

Hospital Only Drug
NICE Guidance - Etanercept for the treatment of Juvenile Idiopathic Arthritis

see attached
Enbrel MyClic (Pfizer Ltd) Off Formulary
Erelzi (Sandoz Ltd) Off Formulary
  Powder and solvent for solution for injection
Enbrel (Pfizer Ltd) Hospital Only
NICE Guidance - Etanercept for the treatment of Juvenile Idiopathic Arthritis

see attached
Enbrel®

Hospital Only Drug
  etoricoxib Off Formulary
The Association of Paediatric Palliative Medicine Formulary - 2015

  flurbiprofen Off Formulary
  golimumab Off Formulary
  hydroxychloroquine sulfate On Formulary
  ibuprofen On Formulary
Guidelines for treating acute pain in paediatric in-patients February 2018

Oxycodone PCA is also approved for acute pain use at RLH.
It is reserved for use after morphine, fentanyl or ketamine combinations have been tried.
Patient Criteria:
1st line – morphine+/- ketamine
2nd line – fentanyl +/- ketamine
3rd line - oxycodone
Duration: approximately 2 weeks
Administration details
Oxycodone 1mg/kg up to 50mg made up to 50mL sodium chloride 0.9%
Bart's Health Clinical Practice Policy on Intravenous PCA/NCA for Paediatric Patients in Acute Pain

see attached
The Association of Paediatric Palliative Medicine Formulary - 2015

see attached
  meloxicam Off Formulary
  methotrexate Hospital Only
Methotrexate

Hospital Use Only
Monitoring blood values while on methotrexate

see attached
Guideline for use of methotrexate in Juvenile Idiopathic arthritis

see attached
Methotrexate Blood Monitoring Schedule

see attached
METHOTREXATE

For Hospital Only - Unless SCG in place
  naproxen On Formulary
  penicillamine Off Formulary
  piroxicam Off Formulary
  rituximab Off Formulary
  Solution for infusion
MabThera (Roche Products Ltd) Hospital Only
  sulfasalazine On Formulary
  Gastro-resistant tablet
Sulfasalazine (Non-proprietary) On Formulary
  Oral suspension
Sulfasalazine (Non-proprietary) On Formulary
  tocilizumab Off Formulary NICE TA238
NICE TA373
TOCILIZUMAB

Hospital Only Drug (supply from tertiary centre)
 
Tocilizumab would normally be supplied by GOSH (or other tertiary shared care centre for paediatric rheumatology).
  Solution for infusion
RoActemra (Roche Products Ltd) On Formulary
RoActemra®

Hospital Only Drug

Tocilizumab would normally be supplied by GOSH (or other tertiary shared care centre for paediatric rheumatology).

  ustekinumab Off Formulary NICE TA455
Paediatric Crohn’s disease aged 3-18yrs

4th line treatment (see attached algorithm below)

IV infusion loading dose 6mg/kg at week 0, followed by 8 weekly subcutaneous injection 45 mg (≤ 45kg) or 90 mg (>45kg) – weight dependent

 

DTC DEC 2021

Approval recevied to increase dosing frequency-  schedule to 6 weekly for 1 patient/year and 4 weekly for 1 patient every 2 years
July 2024 - Ustekinumab for refractory Crohn’s disease in pre-pubescent children

The licence has been extened for ustekinumab in children aged 6 years and over for paediatric plaque psoriasis, application of the Commissioning Medicines for Children policy also enables access to children aged 6 years and over with Crohn’s disease.
Musculoskeletal system / Hyperuricaemia and gout
  allopurinol On Formulary
  canakinumab Off Formulary
  diclofenac potassium Off Formulary
  diclofenac sodium On Formulary
The Association of Paediatric Palliative Medicine Formulary - 2017

see attached
Guidelines for treating acute pain in paediatric in-patients 2018

see attached
  etoricoxib Off Formulary
The Association of Paediatric Palliative Medicine Formulary - 2015

  naproxen Off Formulary
Musculoskeletal system / Local inflammation of joints and soft tissue
  dexamethasone On Formulary
Perioperative Prevention of Post Operative Nausea and Vomiting in Paediatric Patients 2017

See attached
DEXAMETHASONE

'Dexamethasone 0.1% eye ointment can also be used for infected gastrostomy sites (off-label)
Management of Acute Asthma in Children

Single oral dose 0.6mg/kg (max 16mg) - Approved

(equivalent to 3 days of oral prednisolone)
  Oral solution
Dexamethasone (Non-proprietary) On Formulary
  hydrocortisone On Formulary
  Solution for injection
Hydrocortisone (Non-proprietary) On Formulary
  methylprednisolone On Formulary
Solu-Medrone®

Injection Formulation is Hospital Use Only
Intramuscular depot

Injection Formulation is Hospital Use Only
Depo-Medrone®

Injection Formulation is Hospital Use Only
METHYLPREDNISOLONE

Crohn's disease with joint involvement- *Rheumatology recommendation only *

Alternative to prednisolone/hydrocortisone for severe Inflammatory Bowel Disease or disease not responding to an oral corticosteroid

  Powder and solvent for solution for injection
Solu-Medrone (Pfizer Ltd) On Formulary
METHYLPREDNISOLONE

Crohn's disease with joint involvement- *Rheumatology recommendation only *

Alternative to prednisolone/hydrocortisone for severe Inflammatory Bowel Disease or disease not responding to an oral corticosteroid
Solu-Medrone®

Injection Formulation is Hospital Use Only

  Suspension for injection
Depo-Medrone (Pfizer Ltd) On Formulary
Depo-Medrone®

Injection Formulation is Hospital Use Only

  prednisolone On Formulary
Prednisolone soluble tablets

Non-formulary (except long term patients with compliance issues)
  triamcinolone acetonide On Formulary
  Suspension for injection
Adcortyl Intra-articular / Intradermal (Bristol-Myers Squibb Pharmaceuticals Ltd) On Formulary
Kenalog (Bristol-Myers Squibb Pharmaceuticals Ltd) On Formulary
Kenalog® Intra-articular/Intramuscular

Hospital Only Drug
Musculoskeletal system / Soft tissue disorders
  hyaluronidase On Formulary
Musculoskeletal system / Muscular dystrophy
  ataluren Off Formulary NICE HST22
  nusinersen Off Formulary NICE TA588
Musculoskeletal system / Myasthenia gravis and Lambert-Eaton myasthenic syndrome
  neostigmine On Formulary
NEOSTIGMINE

Injection Formulation is Hospital Only

NEONATAL FORMULARY BARTS HEALTH

Neonatal Formulary  Barts Health
NEOSTIGMINE METILSULFATE

Hospital Use Only
  Solution for injection
Neostigmine (Non-proprietary) Hospital Only
Injection

Hospital Only Drug
NEONATAL FORMULARY VERSION 9 2016 BARTS HEALTH

Neonatal Formulary Version 9 2016 Barts Health
NEOSTIGMINE METILSULFATE

Hospital Use Only
  pyridostigmine bromide On Formulary
NEONATAL FORMULARY VERSION 9 2015 BARTS HEALTH

Musculoskeletal system / Nocturnal leg cramps
  quinine Off Formulary
The Association of Paediatric Palliative Medicine Formulary - 2017

see attached
Musculoskeletal system / Spasticity
  baclofen On Formulary
BACLOFEN

Injection Formulation is Hospital Only

The Association of Paediatric Palliative Medicine Formulary - 2017

see attached
  Oral solution
Baclofen (Non-proprietary) On Formulary
  Solution for infusion
Baclofen (Non-proprietary) Hospital Only
Lioresal (Novartis Pharmaceuticals UK Ltd) Hospital Only
  dantrolene sodium On Formulary
The Association of Paediatric Palliative Medicine Formulary - 2017

see attached
  Powder for solution for injection
Dantrium (Forum Health Products Ltd) Hospital Only
  diazepam On Formulary
Diazepam

Injection formulation is Hospital Only

Sickle-Cell-Disease Management in Children

see attached
The Association of Paediatric Palliative Medicine Formulary - 2017

see attached
NEONATAL FORMULARY VERSION 10 2018 BARTS HEALTH

see attached