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REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Adult Joint Formulary

10.3 Neuromuscular disorders

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10.3.1 Myasthenia gravis and Lambert-Eaton myasthenic syndrome

First line drugs Second line drugs Specialist drugs Secondary care drugs



Neostigmine (TLS Green)

  • Only on the recommendation of a Consultant Neurologist

Pyridostigmine (TLS Green)


10.3.2 Nocturnal leg cramps

Link to BNF Nocturnal leg cramps

Quinine sulphate (TLS Green)


10.3.3 Spasticity

Alpha 2 -Adrenoceptor Agonists

Tizanidine (TLS Green)

  • Only on the recommendation of a Neurologist or pain clinic
  • Caution in renal impairment


Gamma-Aminobutyric Acid Analogues and Derivatives

Baclofen (TLS Green)

  • Baclofen may lead to reversible neurological changes and coma in people with low kidney function. Start at very low doses at very long intervals in these patients and titrate to effect

Baclofen (intrathecal) (TLS Red)


Muscle Relaxants

Dantrolene (TLS Green)

Diazepam (TLS Green)



Nusinersen (TLS Red) 

  • NICE TA588 Nusinersen for treating spinal muscular atrophy


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