netFormulary NHS
Milton Keynes Formulary
Milton Keynes University Hospital NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes Clinical Commissioning Group
Milton Keynes Community Health Services
 Search
 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01.01  Expand sub section  Non-steroidal anti-inflammatory drugs
 note 

Non-Steriodal inflammatory drugs (NSAID)

 

Only prescribe an NSAID if the benefits of treatment clearly outweigh the risks and a need for an anti-inflammatory agent is identified.       

3 Steps to NSAID Prescribing

Don’t use them unless you have to

  • The only way to avoid NSAID side-effects is not to use them
  • Paracetamol works for many
  • Employ non-drug interventions routinely
  • Consider short-term course (1-2 weeks) of topical NSAID

If you have to use them, use them wisely

  • The balance of benefits and risks needs to be carefully assessed; think about CV, GI and renal issues routinely.
  • Use a safer drug (ibuprofen, then naproxen) in the lowest effective dose for the shortest period
  • NSAID users should be a high priority for medication review: are NSAIDs effective/needed? Drug holidays? Don’t issue repeat prescriptions without review.
  • Short acting NSAIDs are preferred for the majority of patients as they allow flexible dosing leading to better control of symptoms using lower daily doses.

Consider gastroprotection in those at high risk (NICE definition)

  • Options are PPIs, double-dose H2RAs, Misoprostol
  • COX-2 should be considered only in those at high GI risk, but also consider the CV risks.
  • Systemic as well as local effects of NSAIDs contribute to gastrointestinal damage. This damage may not be prevented by the use of enteric-coated tablets or suppositories.
Ibuprofen
(Oral)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Ibuprofen Tablets 200mg, 400mg, 600mg
  • Suspension SF 100mg in 5ml

Notes:

  • Should not be prescribed in Primary Care or at Discharge.
  • Advise patient to purchase, unless prescription is for long-term regular use.
  • Treatment should be reviewed after two weeks and stopped if not effective.
 
Link  MHRA: High dose ibuprofen (2400mg): small increase in cardiovascular risk (2015)
Link  UKMI Q&A: Can breastfeeding mothers take ibuprofen?
   
Naproxen
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 250mg, 500mg

 
   
Diclofenac
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2
  • Tablets e/c 25mg, 50mg
  • Dispersible tablets 50mg
  • Suppositories 12.5mg, 25mg, 50mg, 100mg
  • Injection 75mg in 3ml

AKIS 75 mg/ml solution for injection - Hospital Use only

 
Link  2018 (DTB): MI risk higher with diclofenac than naproxen (2018)
Link  2013 (MHRA): Contraindications and warnings due to CV risk
Link  2013 (MHRA): Patient information on CV risk
   
Flurbiprofen
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Tablet 50mg

 
   
Indometacin
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2
  • Capsules 25mg, 50mg
  • Suppositories 100mg
 
   
Mefenamic Acid
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2
  • Capsule 250mg (cost effective choice)
  • Tablets 500mg

Notes:
a) Restricted to first line use only in patients that require a reduction in blood flow, e.g. patient with both menorrhagia and dysmenorrhea.
b) Restricted to second line use in patients intolerant to other NSAIDs.

 
   
Celecoxib
View adult BNF View SPC online View childrens BNF
Formulary
Amber 2

Tablets 100mg, 200mg

 
   
10.01.01  Expand sub section  Aspirin
 ....
 Non Formulary Items
Aceclofenac

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  MHRA: updated cardiovascular advice for aceclofenac
 
Acelofenac  (Preservex)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Acemetacin  (Emflex)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Azapropazone  (Rheumox)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Celecoxib  (Celebrex)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Dexibuprofen  (Seractil)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Dexketoprofen  (Keral)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Diclofenac with Misoprostol  (Arthrotec 50 and 75)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Etodolac

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Etoricoxib

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  MHRA Drug Safety Update (Oct 2016)
 
Fenbufen

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Fenoprofen  (Fenopron)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ibuprofen  (Brufen Retard)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ibuprofen and famotidine  (Duexis)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ketoprofen

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ketoprofen  (Axorid®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Lumiracoxib  (Prexige)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Meloxicam

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nabumetone

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Naproxen & esomeprazole  (Vimovo)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Naproxen with Misoprostol  (Napratec)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Piroxicam

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Sulindac

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tenoxicam  (Mobiflex)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tiaprofenic Acid

View adult BNF View SPC online View childrens BNF
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
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Routine prescribing within licensed indication  

Amber 1

Specialist recommendation followed by GP initiation and continuation  

Amber 2

Specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation   

Amber 3

Specialist initiation and stabilisation followed by GP continuation  

Amber SCG

Specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline  

Red

Hospital or specialist prescribing only  

Red Red

These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.  

netFormulary