Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
10.1. Drugs used in rheumatic diseases and gout

10.1.1. Non-steroidal anti-inflammatory drugs

Preferred List
Preferred List First Line
IBUPROFEN

Restrictions:

Use of MR preparations is restricted. Modified-release preparations of any NSAID should be restricted to patients with early morning stiffness or compliance problems as they encourage regular/higher doses of NSAIDs and do not afford flexibility in reducing the dose.

BNF Link

Preferred List First Line
NAPROXEN (tablets)

Prescribing Notes:

There is a significant cost difference between the tablets and the enteric coated tablets.

BNF Link

CELECOXIB

Restrictions:

Use in ankylosing spondylitis remains non-Formulary.

BNF Link

ETODOLAC
Total Formulary
DICLOFENAC

Restrictions:

Use of MR preparations is restricted. Modified-release preparations of any NSAID should be restricted to patients with early morning stiffness or compliance problems as they encourage regular/higher doses of NSAIDs and do not afford flexibility in reducing the dose.

Prescribing Notes:

In June 2013, the MHRA issued new contraindications and warnings for diclofenac following a review of the cardiovascular risk, which it states is similar to that of the selective COX-2 inhibitors.  A summary of the guidance on the MHRA website is available HERE

BNF Link

DICLOFENAC AND MISOPROSTOL (ARTHROTEC)

Prescribing Notes:

In June 2013, the MHRA issued new contraindications and warnings for diclofenac following a review of the cardiovascular risk, which it states is similar to that of the selective COX-2 inhibitors.  A summary of the guidance on the MHRA website is available HERE

BNF Link

ETORICOXIB

Restrictions:

Restricted to use in acute gout only. Other indications, including the use in the treatment of ankylosing spondylitis which has not been accepted by SMC, are non-Formulary.

BNF Link

MELOXICAM
NAPROXEN (effervescent tablets)

Restrictions:

Restricted to use in patients unable to swallow naproxen tablets.

BNF Link