Pan Mersey Formulary


	Pan Mersey Area Prescribing Committee

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Formulary Chapter 6: Endocrine system - Full Chapter

Notes:

Coronavirus guidance

Guidance to support primary care prescribers and pharmacists is available from the MLCSU Coronavirus guidance resource page. Links are provided to national resources and regional documents produced by MLCSU, RDTC, and SPS for use by Pan Mersey APC, LSCMMG, and GMMMG.

The list of resources will be updated as new material becomes available so please check back regularly for updates.

The Pan Mersey APC supports the use of COVID-specific guidance issued by NICE, and NHS England and NHS Improvement. During the COVID pandemic this will supersede any APC advice.

Endocrine system

Review date: January 2023

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 ) 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.

NHS England Specialised Commissioning: Key documents

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...

06.03.02

Glucocorticoid therapy

Prednisolone non-enteric coated tablets

Formulary

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. Prices vary - use the cheapest option available.

Amber Initiated Paediatrics

Dexamethasone

Formulary

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

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

Amber Initiated Paediatrics

Dexamethasone injection

Formulary

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

DEXAMETHASONE injection – different injection strengths. Pan Mersey Area Prescribing Committee Safety Notice

Hydrocortisone

Formulary

tablets 10mg, 20mg

oral suspension 5mg in 5mL (Special)

Paediatrics

Hydrocortisone acetate injection

Formulary

25mg/mL, 1mL amp

Methylprednisolone tablets

Formulary

2mg, 4mg, 16mg, 100mg

Amber Initiated Paediatrics

Hydrocortisone sodium succinate

Formulary

Injection 100mg

Red Paediatrics

Methylprednisolone acetate injection

Formulary

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

Red Paediatrics

Methylprednisolone injection

Formulary

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

Red Paediatrics

MHRA (2017). Methylprednisolone injectable medicine containing lactose (Solu-Medrone 40 mg): do not use in patients with cows’ milk allergy

Betamethasone soluble tablets

Formulary

500micrograms (as sodium phosphate)

Amber Initiated Paediatrics

Deflazacort

Formulary

tablets 6mg

oral drops 22.75mg in 1mL (unlicensed import)

For use in paediatrics only

Hydrocortisone sodium phosphate

Formulary

Injection 100mg/1ml

For patients with adrenocortical insufficiency who may occasionally require intramuscular injection in an emergency when unable to take their oral medication. This decision would be made by a specialist.

Specialist will ensure the patient has been appropriately trained to be able to administer I.M. hydrocortisone.
Specialist will communicate to the GP that the patient has had appropriate training for I.M. administration
Secondary care will supply the needles and syringes as necessary to patients (as not able to be prescribed on FP10 prescription).
Hydrocortisone injection and sharps disposal containers can be prescribed on FP10 prescription in primary care.

Prednisolone enteric coated tablets

Formulary

2.5mg, 5mg

Pan Mersey APC (2015) PREDNISOLONE ENTERIC COATED tablets

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Medicines considered suitable for non-specialist prescribing in primary or secondary care.
	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. 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 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
	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.
	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.
	Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.
	Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.
	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.