netFormulary NHS
Nottinghamshire Area Prescribing Committee
Joint Formulary
 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
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10.01.04  Expand sub section  Gout and cytotoxic-induced hyperuricaemia
10.01.04  Expand sub section  Acute attacks of gout
10.01.04  Expand sub section  Long-term control of gout
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Link  SFH: Allopurinol dose advice table
Febuxostat (Adenuric )
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Restricted Drug Restricted
  • For use only in line with NICE guidance for patients intolerant of allopurinol (due to adverse effects sufficient to warrant discontinuation, or to prevent full dose escalation for optimal effectiveness) or for whom allopurinol is contraindicated. 
  • Link  Link to reviews
    Link  MHRA advice regarding risk of serious hypersensitivity reactions
    Link  MHRA: increased risk of cardiovascular death and all-cause mortality in patients with major cardiovascular disease
    Link  NICE TA164: Hyperuricaemia - febuxostat
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    500mg tablet (available as unlicensed import only)

    • Restricted for specialist use only
    • Used with procaine benzylpenicillin in neuro syphilis. 500mg qds. Refer all patients to GUM.
    • Tablets disperse in water if needed. See here for general advice on dispersing tablets.
    Link  BASHH - UK national guidelines on the management of syphilis 2015. For reference only, refer all patients to GUM.
    10.01.04  Expand sub section  Hyperuricaemia associated with cytotoxic drugs
     Non Formulary Items

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    Non Formulary
    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
    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
    Scottish Medicines Consortium
    Cytotoxic Drug
    Cytotoxic Drug
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHS England

    Traffic Light Status Information

    Status Description


    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.


    Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.


    Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.