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. Musculoskeletal and joint diseases

10.2. Drugs used in neuromuscular disorders

10.2.1. Drugs that enhance neuromuscular transmission

Preferred List
Specialist and GP
PYRIDOSTIGMINE BROMIDE

Restrictions: Restricted to specialist initiation.

Prescribing Notes:

This medication is used for myasthenia gravis.

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Total Formulary
Specialist and GP
NEOSTIGMINE

Restrictions: Restricted to specialist initiation.

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Specialist Only
EDROPHONIUM

Restrictions: Restricted to specialist use only.

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10.2.2. Skeletal muscle relaxants

Preferred List
QUININE

Prescribing Notes:

Available as quinine sulphate and quinine bisulphate tablets, oral quinine is used primarily for nocturnal leg cramps. Patients should be reviewed regularly to establish benefit.

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BACLOFEN

Restrictions: Baclofen injection is restricted to use in specialist units only. Slow withdrawal of baclofen over one to two weeks is recommended.

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Total Formulary
Specialist and GP
TIZANIDINE

Restrictions: Restricted to specialist initiation. Restricted to recommendation by designated specialists.

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Specialist and GP
DANTROLENE

Restrictions: Restricted to specialist initiation.

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DIAZEPAM

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10.2.3. Other neuromuscular drugs

Total Formulary
Specialist Only
NUSINERSEN (injection)

Restrictions:

Restricted to specialist use only for the treatment of type II and III 5q spinal muscular atrophy (SMA). 

Prescribing Notes:

  • This therapy is available via the Scottish Government Ultra-orphan pathway
  • Formulary status will be reconsidered following the reassessment by SMC (expected July 2022).
  • SMA type I is already accepted for use by SMC and is available in the GGC Paediatric Formulary.

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Specialist Only
MEXILETINE (capsules)

Restrictions:

Restricted to specialist use for the symptomatic treatment of myotonia in adults with non-dystrophic myotonic disorders.

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