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Area Prescribing Committee
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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:

Review date: Sept 2019 (Currently under review).

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

Medications which are indicated for medically assisted reproduction, including ovulation induction (e.g. clomifene, letrozole and tamoxifen) and assisted reproduction, such as In Vitro Fertilisation or Ex Vitro Fertilisation (e.g. gonadotrophins) are restricted to use by specialist secondary care physicians, and are categorised as RED drugs for these purposes.

 Details...
06.01  Drugs used in diabetes
 note 

 

06.01.01  Insulins
 note 

Insulin should always be prescribed by brand to reduce the risk of confusion.

Pan Mersey APC (2019). INSULIN: reducing errors in prescribing and administration

Wherever possible, when dispensing insulin, the patient or their representative should be shown the container and confirmation obtained that it is the product that is expected.

Insulin should always be prescribed in ‘units’, abbreviations such as ‘iu’ or ‘u’ should never be used.

All patients prescribed insulin should carry an Insulin Passport The adult patient’s passport to safer use of insulin. National Patient Safety Agency Resources.

Choice of insulin

NICE makes recommendations around the regimes that should be offered for the different patient groups. If these are not suitable for the particular needs of the individual patient, alternative regimes may be considered.

All devices for each insulin on the Formulary are included in the Formulary, with the choice depending on patient factors.

Patients should not be changed from the insulin that they are currently receiving without advice from a specialist or a clinician with the appropriate skills and expertise.

Transfer of insulin prescribing to primary care prescriber

Before requesting that Primary Care take over prescribing of newly initiated insulin the specialist team must be assured that the patient is willing, competent and trained to:

  • administer the insulin (or District Nurse arranged)
  • if and when required amend the dose of the insulin, either with the support of their diabetes HCP or independently.

During this time prior to requesting Primary Care take over prescribing, the specialist team must maintain clinical responsibility, review the patient (either face to face or by telephone) and prescribe the insulin and administration devices for:

  • a minimum of 4 weeks supply OR
  • a supply length that allows enough time for the patient to be reviewed by the specialist team, whichever of the above is the longer.’

A copy of the final review must be sent to the primary care prescriber with the request for transfer of prescribing.

06.01.01.01  Short-acting insulins
Insulin Aspart
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

100 units/ml

Fiasp®Novorapid®

Prescribers and patients need to be aware of the faster initial absorption of insulin with Fiasp® resulting in a more rapid onset of action (5 minutes earlier than with Novorapid®) and earlier peak concentration.

Prescribe by brand name.  

 
   
Insulin Glulisine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
100units/ml
Apidra 
   
Insulin Lispro 100 units/mL
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

100 units/ml

Humalog®

Insulin Lispro Sanofi®  (biosimilar)

Prescribe by brand name

 
   
Insulin Lispro 200 units/mL
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
200 units/ml
Humalog 
   
Insulin - Highly purified animal
View adult BNF View SPC online View childrens BNF
Formulary
Black

note Existing patients or strong patient preference only

Hypurin Bovine Neutral
Hypurin Porcine Neutral

 
   
Insulin - Human sequence
View adult BNF View SPC online View childrens BNF
Formulary
Black

note  Existing patients or strong patient preference only

Actrapid
Humulin S
Insuman Rapid

Red Actrapid and Humulin S for hospital in-patient use

 
   
06.01.01.02  Intermediate- and long-acting insulins
Isophane Insulin Human sequence
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
100 units/ml
Insulatard
Humulin I
Insuman Basal 
   
Biphasic Insulin Aspart
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
NovoMix 30 
   
Biphasic Insulin Lispro
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
Humalog Mix25
Humalog Mix50 
   
Biphasic Isophane Insulin Human sequence
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
Humulin M3
Insuman Comb 15
Insuman Comb 25
Insuman Comb 50 
   
Insulin Degludec
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

100 units/mL; 200 units/mL

Tresiba

 
Link  Insulin DEGLUDEC 100 units/ml and 200 units/ml solution for subcutaneous injection (Tresiba®); Pan Mersey Area Prescribing Committee Policy Statement
   
Insulin Detemir
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated
100 units/mL
Levemir 
   
Insulin Glargine
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

100 units/mL

Lantus

Abasaglar (biosimilar)

Semglee (biosimilar)

 
   
Insulin Glargine 300 units/mL
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

300 units/ml Toujeo Not interchangeable with insulin glargine 100 units/mL

 
   
Insulin Zinc Suspension Highly purified animal
View adult BNF View SPC online View childrens BNF
Formulary
Black
Existing patients or strong patient preference only.
Hypurin Bovine Lente 
   
Isophane Insulin Highly purified animal
View adult BNF View SPC online View childrens BNF
Formulary
Black
Existing patients or strong patient preference only.
Hypurin Bovine Isophane
Hypurin Porcine Isophane  
   
Protamine Zinc Insulin
View adult BNF View SPC online View childrens BNF
Formulary
Black
Existing patients or strong patient preference only
Hypurin Bovine Protamine Zinc 
   
Biphasic Isophane Insulin Highly purified animal
View adult BNF View SPC online View childrens BNF
Formulary
Black
Existing patients or strong patient preference only
Hypurin Porcine 30/70 Mix 
   
06.01.01.03  Hypodermic equipment to top
Needle-free insulin delivery system
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

Injex®

InsuJet®

Not routinely recommended unless there is a confirmed diagnosis of needle phobia which would result in the patient not injecting insulin.

 
   
06.01.02  Antidiabetic drugs
06.01.02.01  Sulphonyureas
Gliclazide tablets
View adult BNF View SPC online View childrens BNF
First Choice
Green

40mg, 80mg Second choice: M/R 30mg (approximately equivalent in effect to 80mg standard release). M/R 60mg

Amber Initiated  Paediatrics

 
Glimepiride tablets
View adult BNF View SPC online
Second Choice
Green

1mg, 2mg, 3mg, 4mg

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Glipizide tablets
View adult BNF View SPC online
Second Choice
Green

5mg

Paediatrics: No BNFc entry, seek specialist advice 

 
   
06.01.02.02  Biguanides
Metformin tablets
View adult BNF View SPC online View childrens BNF
First Choice
Green

500mg, 850mg

Amber Initiated  Paediatrics

 
Metformin m/r tablets
View adult BNF View SPC online View childrens BNF
Second Choice
Green

500mg

2nd line if standard release metformin not tolerated

Amber Initiated  Paediatrics

 
   
Metformin oral solution
View adult BNF View SPC online View childrens BNF
Second Choice
Green

500mg/5mL sugar-free

2nd line for patients unable to swallow metformin tablets

Amber Initiated  Paediatrics

 
   
06.01.02.03  Other antidiabetic drugs
 note 

Please see NICE NG28 Type 2 diabetes in adults: management.

Repaglinide, although rarely used, is a treatment option in the current NICE guidance.

Thiazolidinediones

Thiazolidinediones reduce peripheral insulin resistance.
Pioglitazone is the only available option and is recommended in accordance with NICE. Treatment should be reviewed at 3-6 months and should only be continued if the person is deriving benefit.
See pioglitazone entry for links to MHRA warnings re increased risk of heart failure, bladder cancer and bone fracture.

Dipeptidylpeptidase-4 [DPP-4] Inhibitors (Gliptins)

DPP-4 inhibitors act by increasing insulin secretion and lowering glucagon secretion.
They are recommended in accordance with NICE and their licensed indications.
For further details see Pan Mersey Gliptins statement.
The MHRA has issued advice on the risk of acute pancreatitis with DPP-4 Inhibitors. See Drug Safety Update

Sodium-glucose co-transporter 2 [SGLT-2] Inhibitors (‘Flozins’)

SGLT-2 inhibitors lower blood glucose by blocking the reabsorption of glucose in the kidneys and promoting excretion of excess glucose in the urine.
They are recommended in accordance with NICE.
For further details see Pan Mersey monotherapy and combination therapy statements.
The MHRA has issued updated advice on the risks with SGLT-2 inhibitors:
Diabetic ketoacidosis
Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)

Glucagon-Like Peptide-1 Receptor  (GLP-1) Agonists

GLP-1 agonists activate the GLP-1 receptor to increase insulin secretion, suppress glucagon secretion and slow gastric emptying. They are available as injectable preparations. Care should be taken that the correct administration schedule is prescribed and administered.
The MHRA has issued updated advice on the risks with SGLT-2 inhibitors:
Use of glucagon-like peptide-1 (GLP-1) receptor agonists has been associated with a risk of developing acute pancreatitis. See MHRA Drug Safety Update: Exenatide (Byetta ▼): risk of severe pancreatitis and renal failure Drug Safety Update - GOV.UK
Further advice is also available on the risk of ketoacidosis when reducing or stopping concomitant insulin. See the Drug Safety Update GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

 

Canagliflozin tablets
View adult BNF View SPC online
Formulary
Green

100mg, 300mg

Sodium-glucose co-transporter 2 (SGLT2) inhibitor

Third-line option when used as monotherapy

Paediatrics: No BNFc entry, seek specialist advice 

 
Link  CANAGLIFLOZIN, DAPAGLIFLOZIN and EMPAGLIFLOZIN as COMBINATION THERAPIES: Pan Mersey Area Prescribing Committee Multiple Policy Statement
Link  CANAGLIFLOZIN, DAPAGLIFLOZIN and EMPAGLIFLOZIN as MONOTHERAPIES: Pan Mersey Area Prescribing Committee Multiple Policy Statement
Link  NICE TA 390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
Link  NICE TA315: Canagliflozin in combination therapy for treating type 2 diabetes
   
Canagliflozin with metformin (Vokanamet®)
View adult BNF View SPC online
Formulary
Black
50mg/850mg; 50mg/1g

Sodium-glucose co-transporter 2 (SGLT2)(combination therapy)

 
Link  CANAGLIFLOZIN with METFORMIN tablets (Vokanamet®▼) Pan Mersey Area Prescribing Committee Policy Statement
   
Dapagliflozin tablets
View adult BNF View SPC online
Formulary
Green

5mg, 10mg

Sodium-glucose co-transporter 2 (SGLT2) inhibitorThird-line option when used as monotherapyPaediatrics: No BNFc entry, seek specialist advice.

Grey for the treatment of Type 1 Diabetes

 
Link  Pan Mersey APC (2019): Dapagliflozin tablets (Forxiga®) in combination with insulin for the treatment of Type 1 Diabetes Mellitus
Link  CANAGLIFLOZIN, DAPAGLIFLOZIN and EMPAGLIFLOZIN as COMBINATION THERAPIES: Pan Mersey Area Prescribing Committee Multiple Policy Statement
Link  CANAGLIFLOZIN, DAPAGLIFLOZIN and EMPAGLIFLOZIN as MONOTHERAPIES: Pan Mersey Area Prescribing Committee Multiple Policy Statement
Link  NICE TA288: Dapagliflozin in combination therapy for treating type 2 diabetes
Link  NICE TA 390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
Link  NICE TA418: Dapagliflozin in triple therapy for treating type 2 diabetes
   
Dapagliflozin with metformin (Xigduo®)
View adult BNF View SPC online
Formulary
Black
5mg/850mg; 5mg/1g

Sodium-glucose co-transporter 2 (SGLT2)(combination therapy)

 
Link  DAPAGLIFLOZIN with METFORMIN tablets (Xigduo®▼) Pan Mersey Area Prescribing Committee Policy Statement
   
Empagliflozin tablets
View adult BNF View SPC online
Formulary
Green

10mg, 25mg

Sodium-glucose co-transporter 2 (SGLT2) inhibitor

Third-line option when used as monotherapy

Paediatrics: No BNFc entry, seek specialist advice 

 

 
Link  CANAGLIFLOZIN, DAPAGLIFLOZIN and EMPAGLIFLOZIN as COMBINATION THERAPIES: Pan Mersey Area Prescribing Committee Multiple Policy Statement
Link  CANAGLIFLOZIN, DAPAGLIFLOZIN and EMPAGLIFLOZIN as MONOTHERAPIES: Pan Mersey Area Prescribing Committee Multiple Policy Statement
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
Link  NICE TA336: Empagliflozin in combination therapy for treating type 2 diabetes
   
Empagliflozin with metformin tablets (Synjardy®)
View adult BNF View SPC online
Formulary
Black
5mg/850mg, 5mg/1000mg, 12.5mg/850mg, 12.5mg/1000mg

Sodium-glucose co-transporter 2 (SGLT2)(combination therapy)
 
Link  EMPAGLIFLOZIN with METFORMIN tablets (Synjardy®▼) Pan Mersey Area Prescribing Committee Policy Statement
   
Ertugliflozin tabletsBlack Triangle
View adult BNF View SPC online
Formulary
Green

5mg, 15mg. For use as monotherapy and in combination with metformin.

Sodium-glucose co-transporter 2 (SGLT2) inhibitor

Third-line option when used as monotherapy. 

Use only with metformin and DPP4 inhibitor for triple therapy,

Paediatrics: No BNFc entry, seek specialist advice 

 
Link  NICE TA572 (2019): Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes
Link  NICE TA583 (2019): Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes
Link  Pan Mersey APC (2019). ERTUGLIFLOZIN film-coated tablets (Steglatro®▼) in a triple therapy regimen for treating type 2 diabetes
Link  Pan Mersey APC (2019): ERTUGLIFLOZIN film-coated tablets (Steglatro®▼) as monotherapy or with metformin for treating type 2 diabetes
   
Liraglutide injection (Saxenda®)
View adult BNF View SPC online View childrens BNF
Formulary
Black

6mg/mL, 3mL prefilled pen

Max dose 3.0mg

Saxenda® is not licensed for the treatment of type 2 diabetes and is not interchangeable with Victoza® brand, which is licensed for type 2 diabetes and used at a lower dose.

 
Link  LIRAGLUTIDE 6 mg/mL solution for injection (Saxenda®▼) for weight management Pan Mersey Area Prescribing Committee Policy Statement
   
Liraglutide injection (Victoza®)
View adult BNF View SPC online
Formulary
Green

6mg/mL, 3mL prefilled pen

 Amber Patient Retained  when used in combination with insulin.

 

GREY when used as monotherapy

 

 Black  Liraglutide with insulin degludec (Xultophy®▼)

 

Paediatrics: No BNFc entry, seek specialist advice 

 

Victoza® is not licensed for obesity/weight management and is not interchangeable with Saxenda® brand, which is licensed for weight management and used at a higher dose. It is recommended liraglutide is prescribed by brand name to avoid confusion.

 
   
Insulin degludec and liraglutide (Xultophy®)
View adult BNF View SPC online
Formulary
Black

Insulin Degludec 100units/ml + Liraglutide 3.6mg/ml solution for injection

Where the combination of a GLP-1 analogue with insulin is clinically indicated, clinicians should continue to prescribe a separate GLP-1 analogue and insulin in line with current Pan Mersey recommendations.

 
   
Insulin glargine and lixisenatideBlack Triangle (Suliqua®)
View adult BNF View SPC online
Formulary
Grey

Insulin Glargine 100 units/ml + Lixisenatide 50 micrograms/ml solution for injection; 3ml pre-filled pen

Insulin Glargine 100 units/ml + Lixisenatide 33 micrograms/ml solution for injection; 3ml pre-filled pen

Where the combination of a GLP-1 analogue with insulin is clinically indicated, clinicians should continue to prescribe a separate GLP-1 analogue and insulin in line with current Pan Mersey recommendations.

 
   
Alogliptin
View adult BNF View SPC online
Formulary
Green

Tablets 6.25mg, 12.5mg, 25mg

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Dulaglutide injection
View adult BNF View SPC online
Formulary
Green

Pre-filled pen 0.75mg, 1.5mg Pre-filled syringe 0.75mg, 1.5mg

Amber Patient Retained when used in combination with insulin.

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Exenatide prolonged release injection
View adult BNF View SPC online
Formulary
Green

m/r, powder and solvent, 2 mg pre-filled pen

Use in accordance with recommendations in NICE NG28.

Amber Patient Retained  when used in combination with insulin - off label indication with insulin.

Paediatrics: No BNFc entry, seek specialist advice 

 
Link  NICE NG28: Type 2 diabetes in adults: management
   
Exenatide standard release injection
View adult BNF View SPC online
Formulary
Green

250 micrograms/mL, 5 microgram/dose prefilled pen (60 doses), 10 microgram/dose prefilled pen (60 doses)

Amber Patient Retained  when used in combination with insulin.

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Pioglitazone tablets
View adult BNF View SPC online
Formulary
Green

15mg, 30mg, 45mg

Glitazone.

Pioglitazone is GREEN. However, please see: - MHRA safety advice Pioglitazone: risk of bladder cancer - MHRA and MHRA/CHM advice: incidence of heart failure increased when pioglitazone is combined with insulin.

No BNFc entry, seek specialist advice 

 
Link  Insulin combined with pioglitazone: risk of cardiac failure MHRA Drug Safety Update January 2011
Link  Pioglitazone: risk of bladder cancer MHRA Drug Safety Update August 2011
   
Saxagliptin tablets
View adult BNF View SPC online
Formulary
Green

2.5mg, 5mg

Dipeptidylpeptidase-4 (DPP-4) Inhibitors

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Saxagliptin with dapagliflozin (Qtern®)
View adult BNF View SPC online
Formulary
Black

5mg/10mg film-coated tablets

 
Link  Oral Combination Products: Pan Mersey Area Prescribing Committee Policy Statement
   
SemaglutideBlack Triangle
View adult BNF View SPC online View childrens BNF
Formulary
Green

0.25mg, 0.5mg, 1mg pre-filled pen

Amber Patient Retained  when used in combination with insulin

 Paediatrics: No BNFc entry, seek specialist advice 

 
   
Sitagliptin tablets
View adult BNF View SPC online
Formulary
Green

25mg, 50mg, 100mg

Dipeptidylpeptidase-4 (DPP-4) Inhibitor

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Linagliptin tablets
View adult BNF View SPC online
Formulary
Green

5mg

Dipeptidylpeptidase-4 (DPP-4) Inhibitors

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Linagliptin with metformin tablets
View adult BNF View SPC online
Formulary
Black

2.5mg/850mg, 2.5mg/1g Dipeptidylpeptidase-4 (DPP-4) Inhibitors

 
   
Alogliptin with metformin tablets
View adult BNF View SPC online
Formulary
Black
12.5mg/1g

Dipeptidylpeptidase-4 (DPP-4) Inhibitors

 
   
Repaglinide tablets
View adult BNF View SPC online
Formulary
Green

500micrograms, 1mg, 2mg

Although rarely used, is a treatment option in the current NICE guidance.

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Lixisenatide injection
View adult BNF View SPC online
Formulary
Green

50 micrograms/mL, 10 micrograms/dose prefilled pen (14 doses) 100 micrograms/mL, 20 micrograms/dose prefilled pen (14 doses) Treatment initiation pack, 10 micrograms/dose prefilled pen and 20 micrograms/dose prefilled pen Incretin mimetic Second line - use only when both exenatide and liraglutide are unsuitable or not tolerated.

Amber Patient Retained  when used in combination with insulin

Paediatrics: No BNFc entry, seek specialist advice 

 
   
06.01.03  Diabetic ketoacidosis to top
06.01.04  Treatment of hypoglycaemia
Glucose (oral)
View adult BNF View childrens BNF
Formulary
Green

Initially glucose 10–20g (e.g. Dextro-Energy tablet) is given by mouth either in liquid form or as granulated sugar or sugar lumps (or dextrose sweets or jelly babies). Approximately 10g of glucose is available from non-diet versions of Lucozade® Energy Original 55mL, Coca-Cola® 100mL, Ribena® Blackcurrant 19mL (to be diluted), 2 teaspoons of sugar, and also from 3 sugar lumps. If necessary this may be repeated in 10–15 minutes. After initial treatment, a snack providing sustained availability of carbohydrate (e.g., a sandwich, fruit, milk, or biscuits) or the next meal, if it is due, can prevent blood-glucose concentration from falling again.

 
   
Glucagon injection
View adult BNF View SPC online View childrens BNF
Formulary
Green

Injection, powder for reconstitution, glucagon hydrochloride with lactose, 1mg vial with prefilled syringe containing water for injection.

Amber Recommended Paediatrics

 
   
Glucose intravenous infusion 10% and 20%
View adult BNF View SPC online View childrens BNF
Formulary
Red
10% (100mg/mL) and 20% (200mg/mL)  
   
Glucose 40% oral gel
View adult BNF View childrens BNF
Formulary
Green
3 x 25g tubes (10g glucose)
1 x 80g bottle (32g glucose) 
   
06.01.04  Chronic hypoglycaemia
Octreotide
View adult BNF View SPC online View childrens BNF
Formulary
Red

Injection 50micrograms/mL ampoules, 500micrograms/mL (1mL vial, !mL prefilled syringe)

 NHS NHSE commissioned drug - see Specialised Commissioning: Key documents for congenital hyperinsulinism


 
   
Chlorothiazide
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Retained

Tablets 250mg (imported), oral suspension 250mg in 5mL (imported)

Paediatrics only

 
   
Diazoxide
View adult BNF View childrens BNF
Unlicensed Drug Unlicensed
Amber Retained

Tablets 50mg, oral suspension 250mg/5ml (imported)

For chronic hypoglycaemia

 
   
06.01.05  Treatment of diabetic nephropathy and neuropathy
Midodrine tablets
View adult BNF View SPC online
Formulary
Amber Initiated

2.5mg, 5mg

Oral alpha agonist treatment for severe orthostatic hypotension due to autonomic dysfunction when corrective factors have been ruled out and other forms of treatment are inadequate.

Paediatrics: No BNFc entry, seek specialist advice 

 
   
06.01.05  Diabetic nephropathy
06.01.05  Diabetic neuropathy to top
06.01.06  Diagnostic and monitoring agents for diabetes mellitus
06.01.06  Blood glucose monitoring
Flash glucose monitor  (FreeStyle Libre®)
Formulary
Amber Initiated

Sensor

(Some clinical systems may describe this as a "kit" containing 1 sensor, 1 sensor applicator and wipe)

Interstitial fluid glucose measurement

 
Link  Pan Mersey APC (2019). Flash glucose monitor (FreeStyle Libre®)
Link  Template initiation criteria confirmation – Freestyle Libre®
Link  Template continuation criteria confirmation – Freestyle Libre®
Link  Template Primary care information– Freestyle Libre®
Link  Template patient contract – Freestyle Libre®
   
06.01.06  Urinalysis
 note 

(a) urine testing for glucose (suitable for screening purposes only, not recommended for diagnosis or monitoring)

First Choice: Mission® Glucose GREEN
Second Choice: Medi-Test® Glucose GREEN; Multistix® GREEN

(b) urine testing for ketones. NICE recommends that ketone monitoring (blood or urine) is considered as part of "sick day rules" for adults with type 1 diabetes, to facilitate self-management of an episode of hyperglycaemia.

First Choice: Mission® Ketone GREEN or Ketostix ®GREEN
Mission® Glucose
View adult BNF View childrens BNF
First Choice
Green
Reagent strips, for detection of glucose in urine 
Medi-Test® Glucose
View adult BNF View childrens BNF
Second Choice
Green
Reagent strips, for detection of glucose in urine. 
   
Multistix®
View adult BNF View childrens BNF
Second Choice
Green

Reagent strips for urine testing for glucose

 
   
Mission® Ketone
View adult BNF View childrens BNF
Formulary
Green
Reagent strips, for detection of ketones in urine.  
   
Ketostix®
View adult BNF View childrens BNF
Formulary
Green
Reagent strips, for detection of ketones in urine 
   
06.01.06  Oral glucose tolerance test
06.02  Thyroid and Antithyroid drugs to top
06.02.01  Thyroid hormones
Levothyroxine sodium
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets: 12.5micrograms, 25 micrograms, 50 micrograms, 75micrograms, 100 micrograms

N.B. 12.5micrograms strength primarily recommended for small dose increments required in paediatrics; this strength is relatively expensive and should not be routinely used in adults unless small dose increment is essential in an individual patient.

Prescribe/ dispense with care to avoid confusion with 125micrograms dosage

Oral solution: 25 micrograms/5mL, 50 micrograms/5mL, 100 micrograms/5mL sugar-free.

 
   
Liothyronine sodium tablets
View adult BNF View SPC online View childrens BNF
Formulary
Red

20 micrograms

5 micrograms (unlicensed)

 

Existing stable patients in primary care may continue to be prescribed liothyronine by the GP where they are satisfied the patient is benefiting specifically from the use of liothyronine.

 
   
Thyroid, desiccated (Armour thyroid)
Formulary
Black
 
Link  DESICCATED THYROID (Armour Thyroid®) for hypothyroidism Pan Mersey Area Prescribing Committee Policy Statement
   
06.02.02  Antithyroid drugs
Carbimazole tablets
View adult BNF View SPC online View childrens BNF
First Choice
Amber Recommended

5mg, 20mg

Patient - specific advice on dose and monitoring must be provided to the GP by the specialist.

 
Propranolol
View adult BNF View SPC online View childrens BNF
First Choice
Green

Tablets: 10mg, 40mg, 80mg, 160mg M/R capsules: 80mg, 160mg Oral solution: 5mg/5ml, 10mg/5ml, 40mg/5ml, 50mg/5ml (50mg/5ml standard strength used at Alder Hey)

First choice Beta-blocker

Amber Initiated  Paediatrics

 
Propylthiouracil tablets
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Recommended
50mg

Patient - specific advice on dose and monitoring must be provided to the GP by the specialist. 
   
06.03  Corticosteroids
06.03.01  Replacement therapy
Hydrocortisone
View adult BNF View SPC online View childrens BNF
First Choice
Green

Standard release tablets 10mg, 20mg

Granules (in capsules for opening) 0.5mg, 1mg, 2mg, 5mg

Oral Suspension 5mg in 5mL (Special)

Amber Initiated  Paediatrics

 
Fludrocortisone
View adult BNF View SPC online View childrens BNF
First Choice
Green

tablets 100micrograms

oral suspension 10micrograms in 1mL (Special)

Amber Initiated  Paediatrics

 
Hydrocortisone modified release tablets (Plenadren®)
View adult BNF View SPC online
Formulary
Black
5mg, 20mg  
   
06.03.02  Glucocorticoid therapy to top
Prednisolone non-enteric coated tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 1mg, 2.5mg, 5mg, 10mg and 25mg

Oral liquid 5mg in 5ml single-dose units (Dompe) Oral liquid 10mg in 1ml x 30ml

Soluble tablets 5mg (more expensive than oral liquid)

Amber Initiated Paediatrics

 
   
Dexamethasone
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets: 500micrograms, 2mg Soluble tablets: 2mg

Oral solution, sugar-free: dexamethasone (as sodium phosphate:) 2mg/5mL

Amber Initiated  Paediatrics

 
   
Dexamethasone injection
View adult BNF View SPC online View childrens BNF
Formulary
Green

Dexamethasone (as sodium phosphate) 3.8mg/mL, 1mL vial

Dexamethasone (as sodium phosphate) 3.3mg/mL, 1mL amp, 2mL vial

N.B. Dexamethasone 4mg/mL injection is no longer available.

Red  Paediatrics

 
Link  DEXAMETHASONE injection – different injection strengths. Pan Mersey Area Prescribing Committee Safety Notice
   
Hydrocortisone
View adult BNF View SPC online View childrens BNF
Formulary
Green

tablets 10mg, 20mg

oral suspension 5mg in 5mL (Special)

Amber Initiated  Paediatrics

 
   
Hydrocortisone acetate injection
View adult BNF View SPC online View childrens BNF
Formulary
Green
25mg/mL, 1mL amp 
   
Methylprednisolone tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

2mg, 4mg, 16mg, 100mg

Amber Initiated Paediatrics

 
   
Hydrocortisone sodium phosphate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Injection 100mg/1ml

Amber Recommended  Paediatrics

 
   
Hydrocortisone sodium succinate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Injection 100mg

Red  Paediatrics

 
   
Methylprednisolone acetate injection
View adult BNF View SPC online View childrens BNF
Formulary
Green

40mg/mL; 1mL, 2mL, 3mL vial

Red  Paediatrics

 
   
Methylprednisolone injection
View adult BNF View SPC online View childrens BNF
Formulary
Green

Injection, powder for reconstitution, methylprednisolone (as sodium succinate) (all with solvent).
40mg, 125mg, 500mg, 1g vial, 2g vials

Red  Paediatrics

 
Link  MHRA: Methylprednisolone injectable medicine containing lactose (Solu-Medrone 40 mg): do not use in patients with cows’ milk allergy, October 2017
   
Betamethasone soluble tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

500micrograms (as sodium phosphate)

Amber Initiated Paediatrics

 
   
Deflazacort
View adult BNF View SPC online View childrens BNF
Formulary
Green

tablets 6mg

oral drops 22.75mg in 1mL (unlicensed import)

Amber Initiated  Paediatrics

 
   
Prednisolone enteric coated tablets
View adult BNF View SPC online View childrens BNF
Formulary
Black
2.5mg, 5mg  
Link  PREDNISOLONE ENTERIC COATED tablets Pan Mersey Area Prescribing Committee Policy Statement
   
06.04  Sex hormones
 note 

NHS England expects GPs to co-operate with their commissioned Gender Identity Clinic (GICs) and to prescribe hormone therapy recommended for their patients by the GIC. They are also expected to co-operate with GICs in patient safety monitoring, by providing basic physical examinations (within the competence of GPs) and blood tests recommended by the GIC. The GIC is expected to assist GPs by providing relevant information and support, including the interpretation of blood test results. Hormone therapy should be monitored at least 6 monthly in the first 3 years and yearly thereafter, dependant on clinical need.

Amber Patient Retained NHSE Interim Gender Dysphoria Protocol and Service Guidelines 2013/14

NHSE Gender Dysphoria Clinical Programme

06.04.01  Female sex hormones and their modulators
06.04.01.01  Oestrogens and HRT
 note 

Green unless otherwise stated. Products in this section (including tibolone) are generally similar in terms of efficacy, safety and cost. In the light of this the main considerations in selecting a product are the prescribing clinicians’ view of suitability based on individual patient factors, and the patient’s own views. Refer to NICE NG23 for guidance and BNF for products available.’

Amber Initiated Paediatrics: Refer to Royal College of Obstetricians and Gynaecologists scientific impact paper (2013): Sex steroid treatment for pubertal induction and replacement in the adolescent girl

Conjugated oestrogens and bazedoxifene acetate
View adult BNF View SPC online
Formulary
Black

Duavive® 0.45 mg/20 mg modified-release tablets

 
Link  Pan Mersey APC (2019): CONJUGATED OESTROGENS and BAZEDOXIFENE ACETATE tablets (Duavive®)
   
Tibolone tablets
View adult BNF View SPC online
Formulary
Amber Recommended

2.5mg.

Add-back therapy for the duration of treatment with a gonadorelin analogue, for the prevention of osteoporosis as a side effect. The first month to be prescribed by the specialist

 
   
06.04.01.01  Hormone replacement therapy
06.04.01.01  Ethinylestradiol to top
Ethinylestradiol
View adult BNF View SPC online View childrens BNF
Formulary
Green

Tablets 10 micrograms, 2 micograms (unlicensed import)

Amber Initiated Paediatrics

 
   
06.04.01.01  Raloxifene
Raloxifene hydrochloride tablets
View adult BNF View SPC online
Formulary
Green

60mg

Paediatrics: No BNFc entry - seek specialist advice

 
Link  NICE TA160: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women
Link  NICE TA161: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
   
06.04.01.02  Progestogens and progesterone receptor modulators
Medroxyprogesterone Acetate tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

2.5mg; 5mg; 10mg

Amber Recommended  Paediatrics

 
   
Norethisterone tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green

5mg

Amber Recommended  Paediatrics < 12 years old

 
   
Progesterone (micronised)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Capsules 100mg

 
   
Ulipristal acetate tablets (Esmya®)
View adult BNF View SPC online
Formulary
Red

Paediatrics: no BNFc entry - seek specialist advice.

 
Link  Pan Mersey APC (2019): ULIPRISTAL 5mg tablets (Esmya®)
Link  MHRA: Esmya (ulipristal acetate) and risk of serious liver injury: new restrictions to use and requirements for liver function monitoring before, during, and after treatment (August 2018)
   
Progesterone
View adult BNF View SPC online
Formulary
Red

Pessaries 200mg

For prevention of miscarriage in women with history of recurrent miscarriage, progesterone pessaries are Red  for the duration of treatment during pregnancy required.

Where low-molecular weight heparin is prescribed in combination with progesterone pessaries, or used alone or with aspirin, for prevention of miscarriage in women with history of recurrent miscarriage it is RED

Paediatrics: no BNFc entry - seek specialist advice

 
Link  NICE NG25: Preterm labour and birth, 2015
   
06.04.02  Male sex hormones and antagonists
 note 

Treatment choice should, in the first instance, take into account patient preference and then be based on the lowest acquisition cost. Testosterone undecanoate oral capsules - not recommended as oral absorption is poor and blood levels are more likely to fluctuate leading to side effects.

Testosterone gel
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Testosterone transdermal gel 50mg/5g, 16.2mg/g, 20mg/g

Red  Paediatrics

 
   
Testosterone decanoate, isocaproate, phenylpropionate and propionate injection
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Testosterone propionate 30mg, testosterone phenylpropionate 60mg, testosterone isocaproate 60mg, and testosterone decanoate 100mg/mL; 1mL amp Intramuscular

Red  Paediatrics

 
   
Testosterone enantate injection
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Testosterone enantate 250mg/mL; 1mL amp Intramuscular

Red  Paediatrics

 
   
Testosterone undecanoate injection
View adult BNF View SPC online View childrens BNF
Formulary
Amber Recommended

Testosterone undecanoate 250mg/mL: 4mL amp and 4mL vial Intramuscular

Red  Paediatrics

 
   
06.04.02  Anti-androgens
Cyproterone Acetate tablets
View adult BNF View SPC online View childrens BNF
Formulary
Amber Initiated

50mg Additionally approved by Pan Mersey APC for treatment of androgenic symptoms in polycystic ovary syndrome (off-label indication). Treatment duration 6 - 12 months, concurrent contraception required.

Amber Patient Retained  Paediatrics

 
   
06.04.02  Dutasteride and finasteride to top
Finasteride tablets
View adult BNF View SPC online
First Choice
Green

5mg

Paediatrics: no BNFc entry - seek specialist advice.

 
Dutasteride capsules
View adult BNF View SPC online
Formulary
Black
500micrograms

 
   
06.04.03  Anabolic steroids
06.05  Hypothalamic and pituitary hormones and anti-oestrogens
06.05.01  Hypothalamic and anterior pituitary hormones and anti-oestrogens
06.05.01  Anti-oestrogens
Clomifene citrate tablets
View adult BNF View SPC online
Formulary
Red

50mg

Paediatrics: no BNFc entry - seek specialist advice.

 
   
06.05.01  Anterior pituitary hormones to top
Chorionic Gonadotrophin injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
Product choice is dependent on organisation 
   
Tetracosactide injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
Tetracosactide 250micrograms (as acetate)/mL, 1mL amp

For testing adrenocortical function 
   
06.05.01  Growth Hormone
Somatropin
(Recombinant Human Growth Hormone)
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection
Brands include: Genotropin®, Humatrope®, Omnitrope®, Norditropin SimpleXx®

 
Link  NICE TA188: Human growth hormone (somatropin) for the treatment of growth failure in children (review)
Link  NICE TA64: Growth hormone deficiency (adults) - human growth hormone
   
06.05.01  Growth hormone receptor antagonists
Pegvisomant
View adult BNF View SPC online
Formulary
Red

Injection, powder for reconstitution, pegvisomant, 10mg vial, 15mg vial, 20mg vial NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Paediatrics: no BNFc entry - seek specialist advice.

 
   
06.05.01  Thyrotropin
06.05.01  Hypothalmic hormones
Gonadorelin injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection, powder for reconstitution, 100microgram vial (with diluent) 
   
06.05.02  Posterior pituitary hormones and antagonists to top
06.05.02  Posterior pituitary hormones
Desmopressin acetate nasal spray
View adult BNF View SPC online View childrens BNF
First Choice
Amber Initiated
10micrograms/metered spray, 6mL unit (60 metered sprays) 
Desmopressin acetate oral lyophilisates
View adult BNF View SPC online View childrens BNF
First Choice
Amber Initiated

Sublingual tablets 60micrograms, 120micrograms, 240micrograms DDAVP® is licensed for diabetes insipidus and DesmoMelt® is licensed for nocturnal enuresis (see Chapter 7).

DesmoMelt® has been given ORALLY by dissolving the sublingual tablet in water. Occasionally a proportion of a dose is administered using this method. Anecdotally, one 120 microgram tablet can be dissolved in 12mL water to give 10microgram/mL solution. (off-label) Do not change formulation without consulting the specialist.

 
Desmopressin acetate tablets
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Initiated

100micrograms, 200micrograms

DDAVP® is licensed for diabetes insipidus and DesmoTab® is licensed for nocturnal enuresis (see Chapter 7).

 
   
Terlipressin acetate injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
Injection, powder for reconstitution, terlipressin acetate, 1mg vial with 5mL diluent

Injection, solution for injection, terlipressin acetate, 0.12mg/mL, 1mg (8.5mL) amp

For oesophageal varices

 
   
06.05.02  Antidiuretic hormone antagonists
Demeclocycline capsules
View adult BNF View SPC online
First Choice
Amber Retained

150mg

Paediatrics: No BNFc entry, seek specialist advice 

 
Tolvaptan tablets
View adult BNF View SPC online
Formulary
Red

15mg, 30mg

NHS NHSE commissioned drug: hyponatraemia in cancer - see Specialised Commissioning: Key documents. (Samsca® brand)


CCG commissioned for autosomal dominant polycystic kidney disease (Jinarc® brand), in accordance with NICE TA358 

CCG commissioned for hyponatraemia in SIADH NOT associated with cancer (Samsca® brand)

Paediatrics: No BNFc entry, seek specialist advice 

 
Link  NICE TA358: Tolvaptan for treating autosomal dominant polycystic kidney disease
Link  Pan Mersey APC, May 2019: TOLVAPTAN tablets (Samsca®) for the treatment of hyponatraemia secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
   
06.06  Drugs affecting bone metabolism
06.06  Osteoporosis
06.06.01  Calcitonin and parathyroid hormone to top
Calcitonin (salmon) / Salcatonin injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
50units/mL, 1mL amp
100units/mL, 1mL amp
200units/mL, 2mL vial  
   
Parathyroid Hormone
View adult BNF View SPC online
Formulary
Red

NHS NHSE commissioned drug - see Specialised Commissioning: Key documents

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Teriparatide injection
View adult BNF View SPC online
Formulary
Red

250micrograms/mL, 2.4mL prefilled pen (20 micrograms/80 microlitres per dose)

Use approved as per NICE TA161, including in patients aged 55 years and over with severe osteoporosis with multiple vertebral fractures and collapse for whom T-score is invalid.

NHS NHSE commissioned drug in male and juvenile osteoporosis - see Specialised Commissioning: Key documents

Paediatrics: No BNFc entry, seek specialist advice 

Forsteo® originator brand  

Movymia® biosimilar brand

Terrosa® biosimilar brand

Prescribe by brand name

 
Link  NICE TA161: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
   
06.06.02  Bisphosphonates and other drugs affecting bone metabolism
 note 

Patients should have a dental check-up (and any necessary remedial work should be performed) before bisphosphonate treatment, or as soon as possible after starting treatment.

During bisphosphonate treatment patients should maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms.

See MHRA Drug Safety Updates:

Review continued bisphosphonate therapy for osteoporosis with patient after 3 years treatment, in light of lack of consistent evidence of further benefit after this time, as per NICE guidance NG56.

06.06.02  Bisphosphonates
Alendronic Acid
View adult BNF View SPC online View childrens BNF
First Choice
Green

Tablets (as sodium alendronate) 10mg

Effervescent tablets 70mg

Oral solution, sugar-free, alendronic acid (as sodium alendronate) 70mg/100mL (4×100mL)

Amber Recommended  Paediatrics

 
Risedronate tablets
View adult BNF View SPC online View childrens BNF
First Choice
Green

5mg, 30mg, 35mg

Amber Recommended  Paediatrics

 
Disodium Etidronate tablets
View adult BNF View SPC online
Second Choice
Green

200mg

Paediatrics: no BNFc entry - seek specialist advice

 
   
Ibandronic acid tablets
View adult BNF View SPC online
Formulary
Green

50mg, 150mg For post-menopausal osteoporosis

Amber Patient Retained  for other indications

Paediatrics: no BNFc entry - seek specialist advice

 
   
Ibandronic acid injection
View adult BNF View SPC online
Formulary
Red

1mg/mL, 3mL prefilled syringe Concentrate for intravenous infusion, 1mg/mL, 2mL vial, 6mL vial

Paediatrics: no BNFc entry - seek specialist advice

 
   
Sodium Clodronate
View adult BNF View SPC online View childrens BNF
Formulary
Red
400mg capsules
520mg tablets
800mg tablets 
   
Zoledronic Acid (Aclasta®)
View adult BNF View SPC online
Formulary
Red

Intravenous infusion, 50micrograms/mL, 100mL bottle Licensed for: Treatment of Paget's disease of bone; Treatment of postmenopausal osteoporosis and osteoporosis in men (including corticosteroid-induced osteoporosis)

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Zoledronic Acid (Zometa®)
View adult BNF View SPC online
Formulary
Red

Concentrate for intravenous infusion, 800micrograms/mL, 5mL (4mg) vial Solution for intravenous infusion, 40micrograms/mL, 100mL (4mg) bottle Licensed for: Reduction of bone damage in advanced malignancies involving bone; Hypercalcaemia of malignancy

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Pamidronate disodium
View adult BNF View SPC online View childrens BNF
Formulary
Red
Concentrate for intravenous infusion:
3mg/mL, 5mL vial, 10mL vial
6mg/mL, 10mL vial
9mg/mL, 10mL vial
15mg/mL, 1mL vial, 2mL vial, 4mL vial, 6mL vial

Intravenous infusion, powder for reconstitution, 15mg vial, 30mg vial, 90mg vial (all with diluent) 
   
06.06.02  Denosumab
Denosumab injection (Prolia®)
View adult BNF View SPC online
Formulary
Amber Initiated

60mg/mL, 1mL prefilled syringe

GREY Bone loss associated with long-term systemic glucocorticoid therapy

 
Link  MHRA: Denosumab (Prolia, Xgeva▼): reports of osteonecrosis of the external auditory canal, June 2017
Link  PAN MERSEY AREA PRESCRIBING COMMITTEE PRESCRIBING POLICY STATEMENT: DENOSUMAB solution for injection (Prolia®) for bone loss associated with long-term systemic glucocorticoid therapy
Link  Pan Mersey APC: Denosumab 60mg prefilled syringe, prescribing support information, January 2017
Link  NICE TA204: Denosumab for the prevention of osteoporotic fractures in postmenopausal women, October 2010
   
Denosumab (XGEVA®)
View adult BNF View SPC online
Formulary
Red

70mg/mL, 1.7mL (120mg) vial

Paediatrics: No BNFc entry, seek specialist advice 

 
Link  MHRA: Denosumab (Prolia, Xgeva▼): reports of osteonecrosis of the external auditory canal, June 2017
Link  MHRA: Denosumab: updated recommendations. Minimising the risk of osteonecrosis of the jaw; monitoring for hypocalcaemia, September 2014
Link  NICE TA265: Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours, October 2012
Link  NICE TA549: Denosumab for preventing skeletal-related events in multiple myeloma (terminated appraisal)
   
06.06.02  Strontium renelate
Strontium ranelate
View adult BNF View SPC online
Formulary
Amber Initiated

Granules 2g/sachet

Strontium ranelate should only be used to treat severe osteoporosis in postmenopausal women and men at high risk of fracture, for whom treatment with other medicinal products approved for the treatment of osteoporosis is not possible. It must not be used in patients with established, current or past history of ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease or those with uncontrolled hypertension. 

Paediatrics: No BNFc entry, seek specialist advice 

 
Link  Strontium ranelate: cardiovascular risk. MHRA Drug Safety Update
   
06.07  Other endocrine drugs to top
06.07.01  Bromocriptine and other dopaminergic drugs
Cabergoline
View adult BNF View SPC online
First Choice
Amber Retained

tablets 500micrograms, 1mg, 2mg

Treatment of hyperprolactinaemia

Paediatrics: No BNFc entry, seek specialist advice 

 
Bromocriptine
View adult BNF View SPC online
Second Choice
Amber Retained

tablets 1mg, 2.5mg capsules 5mg Treatment of hyperprolactinaemia

Paediatrics: No BNFc entry, seek specialist advice 

 
   
Quinagolide
View adult BNF View SPC online
Second Choice
Amber Retained

tablets 75microgram; starter pack of 3×25microgram tabs with 3×50microgram tabs Treatment of hyperprolactinaemia

Paediatrics: No BNFc entry, seek specialist advice 

 
   
06.07.02  Drugs affecting gonadotrophins
 note 

Gonadorelin analogues for endometriosis, precocious puberty, infertility, anaemia due to uterine fibroids. (For other indications, see section 8.3.4)

NHS England expects GPs to co-operate with their commissioned Gender Identity Clinic (GICs) and to prescribe hormone therapy recommended for their patients by the GIC. They are also expected to co-operate with GICs in patient safety monitoring, by providing basic physical examinations (within the competence of GPs) and blood tests recommended by the GIC. The GIC is expected to assist GPs by providing relevant information and support, including the interpretation of blood test results. Hormone therapy should be monitored at least 6 monthly in the first 3 years and yearly thereafter, dependant on clinical need.

Amber Patient Retained  NHSE Interim Gender Dysphoria Protocol and Service Guidelines 2013/14

NHSE Gender Dysphoria Clinical Programme

Pan Mersey APC (2017). Gonadorelin Analogues prescribing support information

Pan Mersey APC (2017). Gonadorelin Analogues GP letter

 

06.07.02  Gonadorelin analogues
Triptorelin injection
View adult BNF View SPC online View childrens BNF
First Choice
Amber Retained

Decapeptyl® SR Injection, (powder for suspension), m/r, triptorelin (as acetate), 3mg vial (with diluent);

 

Decapeptyl® SR Injection, (powder for suspension), m/r, triptorelin (as acetate), 11.25mg vial (with diluent);

 

Gonapeptyl Depot® Injection, (powder for suspension), triptorelin (as acetate), net price 3.75mg prefilled syringe (with prefilled syringe of vehicle);

 

Red Salvacyl® Injection, (powder for suspension), triptorelin (as embonate), 11.25mg vial (with diluent)

 

Use in accordance with its licensed indications:

 

RED St Helen's CCG endometriosis and reduction of uterine fibroids

 

Amber Patient Retained  Precocious puberty

For Halton CCG and Warrington CCG patients attending Warrington and Halton Hospitals, GPs currently initiate treatment on the advice of the Trust

 
Goserelin
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Retained

Zoladex®: goserelin (as acetate) 3.6mg in SafeSystem® syringe applicator; Zoladex® LA: goserelin (as acetate) 10.8mg in SafeSystem® syringe applicator Use in accordance with its licensed indications:

 

RED St Helen's CCG endometriosis and reduction of uterine fibroids

 

Red Infertility

 

Amber Patient Retained  Precocious puberty

For Halton CCG and Warrington CCG patients attending Warrington and Halton Hospitals, GPs currently initiate treatment on the advice of the Trust

 
   
Leuprorelin
View adult BNF View SPC online View childrens BNF
Second Choice
Amber Retained

Prostap® SR DCS: leuprorelin (as acetate) 3.75mg in pre-filled syringe; Prostap® 3 DCS: leuprorelin (as acetate) 11.25mg in pre-filled syringe. Use in accordance with its licensed indications:

 

Red St Helen's CCG endometiosis and uterine fibroids

For Halton CCG and Warrington CCG patients attending Warrington and Halton Hospitals, GPs currently initiate treatment on the advice of the Trust

 

 
   
06.07.02  Breast pain (mastalgia)
06.07.03  Metyrapone to top
Metyrapone
View adult BNF View SPC online View childrens BNF
Formulary
Red
capsules 250mg 
   
06.07.04  Somatomedins
Mecasermin
View adult BNF View SPC online View childrens BNF
Formulary
Red

injection 10mg in 1mL

 NHS NHSE commissioned drug - see Specialised Commissioning: Key documents 


 
   
 ....
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

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

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