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 Formulary Chapter 6: Endocrine system - Full Chapter
06.01  Expand sub section  Drugs used in diabetes
 note 

These Audit tools have been developed by the North West Sussex Medicines Management team to support clinically effective prescribing. They are intended to be used as an aid for practice staff to review patients in line with national guidance, and may be amended to suit individual practice or clinician preferences. They are published as simple Microsoft Word documents to enable easy adaptation.

The information contained in the audit tools is correct at the time of production. Using them does not remove any of the professional obligations to prescribe safely by taking individual patient factors into consideration and clinician discretion with individual patients during the review process is essential. Staff using these audits must concurrently take full account of the practice’s internal governance and quality assurance policies, and work in line with the Data Protection Act 1998.

Audits - please click the link below

Hypoglycaemic Agents

Treatment to control blood glucose must be tailored to each individual patient’s clinical needs with safety paramount. It is generally agreed, and supported by the NICE guideline on type 2 diabetes, that metformin should be used first line and a sulfonylurea second line, unless contraindicated.

The newer hypoglycaemic drugs are all usually third-line options – although effective at reducing HbA1c levels, they all lack robust clinical outcome data, particularly around their cardiovascular effects and long term safety in people with type 2 diabetes. Improvements in surrogate markers (e.g. HbA1c levels) do not automatically confer benefits on patient mortality or morbidity, and risks may become apparent only over time when these agents have more widespread use in a diverse patient population.

This audit tool supports the review of newer hypoglycaemic agent prescribing for patients with Type 2 diabetes to ensure these agents are initiated and continued in accordance with NICE and local guidelines.

06.01.01  Expand sub section  Insulins
06.01.01.01  Expand sub section  Short-acting insulins
Insulin Aspart  (FIASP®)
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Formulary
Blue
100units per ml solution for injection
  • Indication - Diabetes Mellitus in Adults not licensed for under 18 years

  • Pre-filled Pen
  • Cartridge
  • Vial

  • Diabetologist initiation only
  •  
    Link  PCN 271-2017 Fast acting insulin aspart (Fiasp®) for the treatment of diabetes mellitus in adult patients
       
    Insulin Aspart  (NovoRapid®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
    PumpCart®Solution for injection in cartridge, 1 cartridge contains 1.6 ml equivalent to 160 units
    To be used with insulin pump only
  • Pre-filled pen, Penfil cartridges 
  •    
    Insulin Glulisine (Apidra®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
  • Indication - Diabetes Mellitus 
  •    
    Insulin Lispro (Humalog®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
  • Indication - Diabetes Mellitus 
  •    
    06.01.01.01  Expand sub section  Soluble Insulin
    Soluble Insulin  (Actrapid ®)
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    Formulary
    Blue
     
       
    Soluble Insulin  (Humulin S ®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
     
       
    06.01.01.01  Expand sub section  Rapid Acting Insulin Analogues to top
    06.01.01.02  Expand sub section  Intermediate- and long-acting insulins
    Insulin Degludec (Tresiba®)
    (Type 1 and 2 diabetes )
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    Formulary
    Blue
  • 100units/mL & 200units/mL
  • Only for use in Type 1 diabetics who meet the criteria.
    For Consultant initiation only
  • Documented severe hypoglycaemia
  • Risk of hypoglycaemia because of reduced awareness; or Frequent hypoglycaemia which prevents achieving predefined glycaemic targets
    AND individuals should have:
    Received an appropriate level of education with respect to flexible insulin dosing and carbohydrate counting; and
  • Tried other basal insulin regimens including split dose Determir as recommended in NG17
  • Be prepared to complete hospital issued assessment questionnaire
  • This decision is based on Brighton APC decision

    Only for use in Type 2 diabetics who meet the criteria.
    For Consultant initiation only in those poorly controlled patients:
    DotWho do not reach their target HbA1c because of significant hypoglycaemia OR
    DotWho experience significant hypoglycaemia on Neutral Protamine Hagedorn (NPH) and insulin detemir or glargine (100units/ml) irrespective of the level of HbA1c OR
    DotWho cannot use the device needed to inject NPH and insulin detemir or glargine (100units/ml) but who could administer their own insulin safely and accurately if a switch to one of the long acting insulin analogues was made OR
    DotWho need help from a carer or healthcare professional to administer insulin injections and for whom having a wide window for daily administration is essential. A minimum of 8 hours between injections should always be ensured.
     
  • Link  MHRA Drug Safety Update Apr 2013 Degludec available in additional higher strengths than existing insulins – care needed to minimise risk of error, including training for patients
    Link  PCN 217-2016 Degludec in Type 2 Diabetes (updated April 2017)
       
    Insulin Glargine (Lantus®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
  • 100 units/mL SoloStar prefilled pen; vial; cartridge

  • Indication - Diabetes (type 1 and 2) Not for routine use in type 2 diabetics. Type 2's must fall into NICE criteria for eligibility.
  • Prescribe by brand
     
  • Link  MHRA Drug Safety Update 29/04/2015 - High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error
    Link  NICE TA53 - Guidance on the use of long‑acting insulin analogues for the treatment of diabetes – insulin glargine
       
    Insulin Glargine (Toujeo®)
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    Formulary
    Blue
  • 300units/ml
  • Indication -
    Type 1 Diabetes
    Type 2 Diabetes
    Restricted Item Black Triangle 
  • Link  MHRA Drug Safety Update 29/04/2015 - High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error
    Link  PCN Statement 181-2016 Toujeo (insulin glargine 300units/ml) Type 1 diabetes
    Link  PCN statement 182-2016 Toujeo (insulin glargine 300 units/ml) Type 2 diabetes
       
    Insulin Glargine Biosimilar (Abasaglar®)
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    Formulary
    Blue
  • 100 units/mL solution for injection; pre-filled pen; cartridge
  • Indication
  • Diabetes Type I in line with NICE NG17 and PCN statement 199-2016
  • Diabetes Type II in line with NICE NG28 and PCN statement 200-2016 
  • Link  NG17 Type 1 diabetes in adults: diagnosis and management
    Link  NG28 Type 2 diabetes in adults: management
    Link  PCN 199-2106 Abasaglar (Insulin Glargine- Biosimilar) for the treatment of Type I diabetes mellitus in adults, adolescents and children aged 2 years and above.
    Link  PCN 200-2016 Abasaglar (Insulin Glargine- Biosimilar) for the treatment of Type II diabetes mellitus in adults, adolescents and children aged 2 years and above.
       
    Isophane Insulin (Humulin® I)
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    Formulary
    Blue
  • Indication - Diabetes Mellitus
  • First line choice under specialist initiation
  •  
       
    Isophane Insulin (Insulatard®)
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    Formulary
    Blue
  • Indication - Diabetes Mellitus
  • First line choice under specialist initiation
  •  
       
    Isophane Insulin (Insuman® Basal)
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    Formulary
    Blue
  • Indication - Diabetes Mellitus
  • First line choice under specialist initiation
  • Temporary shortage supply of Insulin human - INSUMAN® Basal.
    No new patients should be started on Insuman® Basal(prefilled pens and cartridges) during the shortage and existing patients should be switched to a suitable alternative. (see link below)
    Shortage also affects INSUMAN® Comb 25 (prefilled pens and cartridges)
     
    Link  EMEA Shortage of Insuman Basal and Comb 25 (insulin human)
    Link  Sanofi letter Shortage of Insuman Basal and Comb 25
       
    Insulin Detemir (Levemir®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
  • Indication - Diabetes Mellitus
  • Second line choice under specialist initiation
  •  
    Link  NICE TA53 - Guidance on the use of long‑acting insulin analogues for the treatment of diabetes – insulin glargine
       
    Insulin 500 units in 1mL (Humulin R®U-500)
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    Formulary
    Red
  • Indication - Diabetes
  • unlicensedunlicensed
  •  
       
    Insulin Pump
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    Formulary
    Red

    Continuous subcutaneous infusion

    • Indication - Diabetes Type 1 (adults & children)in line with NICE TA151
    • for children and young people with a non-autoimmune cause for deficiency of beta cells (who do not have type 1 diabetes) TA151

      Prescribing of the pump and consumables would be by hospital specialists only (RED), in line with NICE, using the Blueteq initiation and continuation forms.
      Insulin for use in the pump would continue to be prescribed by the individual patient’s GP

    • Insulin pump therapy recommended as a possible treatment for adults and children with type 1 Diabetes if target HbA1c levels have not been met with multiple daily injections and careful management/multiple daily injections are not practical or appropriate.
    • Insulin pump therapy is not recommended for people with type 2 diabetes mellitus.

    • BlackDiabetes Type 2
     
    Link  MHRA Medical Device Alert Feb 2019 - Accu-Chek Insight insulin pumps
    Link  APC 389-2019 Commissioning of insulin pumps
    Link  PCN 334-2018 Insulin pumps for all age groups with a non-autoimmune cause for deficiency of beta cells
    Link  MHRA Medical Device Alert - Sep 2017 - All Accu-Chek Insight Insulin pumps - risk of alarm failure
    Link  Minimed 640G (Medtronic) Insulin Pump for patients with Type 1 Diabetes - PCN 158-2015 - May 2015
    Link  NICE TA151 - Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus
       
    06.01.01.02  Expand sub section  Biphasic insulins
    Biphasic Insulin Aspart (NovoMix® 30)
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    Formulary
    Blue
  • Indication - Diabetes Mellitus 
  •    
    Biphasic Insulin Lispro (Humalog Mix 25)
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    Formulary
    Blue
  • Indication - Diabetes Mellitus 
  •    
    Biphasic Insulin Lispro (Humalog Mix 50)
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    Formulary
    Blue
  • Indication - Diabetes Mellitus 
  •    
    Biphasic Isophane Insulin (Humulin® M3)
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    Formulary
    Blue
  • Indication - Diabetes Mellitus 
  •    
    06.01.01.02  Expand sub section  Intermediate Acting Insulin
    06.01.01.02  Expand sub section  Long Acting Insulin Analogues
    06.01.01.03  Expand sub section  Hypodermic equipment to top
    Injection Devices (Autopen®24)
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    Formulary
    Blue
    For use with Sanofi-Aventis 3ml cartridges
     
       
    Injection Devices (Autopen®Classic)
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    Formulary
    Blue
    For use with Lilly 3ml cartridges
     
       
    Injection Devices (HumaPen® Luxura HD)
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    Formulary
    Blue
    HD 1-30 unit
  • For use with Humulin® and Humalog® 3ml cartridges
  • Use HumanPen® Savvio as replacement for 1-60unit HumanPen® Luxura
  •  
       
    Injection Devices (HumaPen® Savvio)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
     
       
    Injection Devices (NovoPen®4 )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
    For use with Novo Nordisk 3ml cartridges
  • The manufacturer of NovoPen® 4 has written to healthcare professionals advising that this device is being phased out and replaced by NovoPen® 5.
    It is expected that supplies of the NovoPen® 4 will run out in September 2015.
    The new device will be available in the same colours (blue and silver) and has a memory function
    You may view the latest post at
    http://www.prescriber.org.uk/2015/07/novopen-4-to-be-phased-out/
     
  •    
    Needle free Insulin delivery system (Injex®)
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    Formulary
    Blue
    Administration of insulin to patients diagnosed with true needle-phobia
     
    Link  Needle-free Insulin Devices - Policy Statement PCN 134-2015 - Feb 2015
       
    Needle free Insulin delivery system (Insujet®)
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    Formulary
    Blue
    Administration of insulin to patients diagnosed with true needle-phobia
     
    Link  Needle-free Insulin Devices - Policy Statement PCN 134-2015 - Feb 2015
       
    Pen needles for insulin delivery
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    Formulary
    Green
    • The selected preferred cost-effective needles are:
      o MyLife Penfine Classic (4mm/32g, 6mm/32g, 8mm/31g)
      o Omnican Fine (4mm/31g, 4mm/32g, 5mm/31g, 5mm/32g, 6mm/31g, 6mm/32g 8mm/31g, 10mm/30g, 12mm/29g)
    • The preferred needles should be prescribed for new patients and an informed switch programme for existing patients should be undertaken.

      Black Traffic Light  Safety Needles e.g. BD Auto-shield NOT TO BE Prescribed on FP10. Not to be prescribed for use by SCFT staff -
     
    Link  Brighton APC statement Pen needles
       
    06.01.02  Expand sub section  Antidiabetic drugs
     note 

    Prescribing guidelines for the management of type 2 diabetes in primary care

    06.01.02.01  Expand sub section  Sulphonyureas
    Gliclazide
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    First Choice
    Green

    Tablets
  • Indication - Type 2 Diabetes Mellitus 
  • Glipizide
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    First Choice
    Green

    Tablets
  • Indication - Type 2 Diabetes Mellitus 
  • Gliclazide MR
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    Second Choice
    Green

    Tablets
  • Indication - Type 2 Diabetes Mellitus
  • Reserved for patients with compliance issues who require a once a day treatment 
  •    
    Glimepiride
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    Second Choice
    Green

    Tablets
  • Indication - Type 2 Diabetes Mellitus 
  •    
    06.01.02.02  Expand sub section  Biguanides
    Metformin
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    First Choice
    Green

    Tablets, Oral Solution sugar free

    • Oral solution for patients with swallowing difficulties only
    • Use with caution in renal impairment—increased risk of lactic acidosis; avoid in significant renal impairment. NICE(1) recommends that the dose should be reviewed if eGFR less than 45 mL/minute/1.73 m2 and to avoid if eGFR less than 30 mL/minute/1.73 m2. Withdraw or interrupt treatment in those at risk of tissue hypoxia or sudden deterioration in renal function, such as those with dehydration, severe infection, shock, sepsis, acute heart failure, respiratory failure or hepatic impairment, or those who have recently had a myocardial infarction
    • Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes TA572
    • Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes TA583
     
    Metformin Hydrochloride m/r
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    Second Choice
    Green
    Tablets m/r
  • Where GI complications with immediate release product
  • Use with caution in renal impairment—increased risk of lactic acidosis; avoid in significant renal impairment. NICE(1) recommends that the dose should be reviewed if eGFR less than 45 mL/minute/1.73 m2 and to avoid if eGFR less than 30 mL/minute/1.73 m2. Withdraw or interrupt treatment in those at risk of tissue hypoxia or sudden deterioration in renal function, such as those with dehydration, severe infection, shock, sepsis, acute heart failure, respiratory failure or hepatic impairment, or those who have recently had a myocardial infarction.

    Sukkarto®SR
  • A cost-effective option
  •  
    Link  PCN 163-2015 metformin renal impairment
    Link  Type 2 diabetes in adults: management NG28
       
    06.01.02.03  Expand sub section  Other antidiabetic drugs
     note 

    Liraglutide i/r, exenatide i/r and exenatide m/r can be initiated in triple therapy (with metformin and a sulfonylurea OR metformin and a thiazolidinedione) when HbA1c 7.5% / 58 mmol/mol (or higher as agreed with patient) and:

    BMI ≥ 35kg/m2 (in patients of European descent – appropriate adjustment for other ethnic groups) and there are specific psychological/medical problems associated with high body weight or

    BMI < 35kg/m2 and insulin therapy has significant occupational implications or weight loss would benefit other obesity-related co-morbidities

    Treatment can be continued if there is a beneficial metabolic response (1% reduction in HbA1c and 3% weight loss in 6 months).

    Liraglutide i/r and exenatide m/r can be initiated in dual therapy (with metformin or a sulfonylurea) when:

    The patient is intolerant to metformin or sulfonylureas or treatment with metformin or a sulfonylurea is contraindicated and

    The patient is intolerant to thiazolidinediones and DPP-4 inhibitors or treatment with thiazolidinediones and DPP-4 inhibitors is contraindicated.

    Treatment can be continued if there is a beneficial metabolic response (1% reduction in HbA1c in 6 months).

    Dipeptidylpeptidase 4 (DPP-4) inhibitors
    Continue DPP-4 inhibitors only if there is a reduction ≥ 0.5 percentage points in HbA1c within 6 months of starting treatment.
    Patients taking gliptins should be made aware of the symptoms of pancreatitis and to seek help if they develop.

    Nateglinide
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    Formulary
    Green

    Tablets

     
       
    Repaglinide
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    Formulary
    Green

    Tablets

    • Rapid onset of action and short duration of activity
    • Consider a rapid-acting insulin secretagogue as an alternative to sulfonylurea if the person has an erratic lifestyle or meal pattern
    • Licensed as monotherapy
    • Licensed as dual therapy in combination with metformin
       
       
     
       
    Pioglitazone
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    Formulary
    Green

    Tablets

     
    Link  MHRA Drug Safety Update 01/2011 - Insulin combined with pioglitazone: risk of cardiac failure
    Link  MHRA Drug Safety Update 08/2011 - Pioglitazone: risk of bladder cancer
       
    06.01.02.03  Expand sub section  DPP-4 inhibitors to top
    Alogliptin
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    Formulary
    Green
  • Tablets
  • Indication - Diabetes (type 2) - in accordance with NICE criteria for both initiation and continuation of therapy
  •  
    Link  Type 2 diabetes in adults: management NG28
       
    Linagliptin
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    Formulary
    Green

    Tablets

    • For renal impairment only
     
    Link  Drug Safety Update 09/2012 - Dipeptidylpeptidase-4 inhibitors: risk of acute pancreatitis
    Link  Type 2 diabetes in adults: management NG28
       
    Saxagliptin
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    Formulary
    Green
  • Tablets
  • Indication - Diabetes (type 2) - in accordance with NICE criteria for both initiation and continuation of therapy
  •  
    Link  Drug Safety Update 09/2012 - Dipeptidylpeptidase-4 inhibitors: risk of acute pancreatitis
    Link  Type 2 diabetes in adults: management NG28
       
    Sitagliptin
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    Tablets

    • Indication - Diabetes (type 2) - in accordance with NICE criteria for both initiation and continuation of therapy
     
    Link  Drug Safety Update 09/2012 - Dipeptidylpeptidase-4 inhibitors: risk of acute pancreatitis
    Link  Type 2 diabetes in adults: management NG28
       
    Vildagliptin
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    Formulary
    Green

    Tablets
  • Indication - Diabetes (type 2) - in accordance with NICE criteria for both initiation and continuation of therapy
  • Monitor liver function before and every 3 months during therapy due to rare reports of liver dysfunction
  •  
    Link  Drug Safety Update 09/2012 - Dipeptidylpeptidase-4 inhibitors: risk of acute pancreatitis
    Link  Type 2 diabetes in adults: management NG28
       
    06.01.02.03  Expand sub section  GLP-1 mimetics
    Dulaglutide (Trulicity®)
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    Formulary
    Green

    Indication Treatment option for type 2 diabetes in line with NICE (NG28)

    • See PCN 194-2016
     
    Link  MHRA Drug Safety Update Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
    Link  NICE NG28 - Type 2 diabetes in adults: management
    Link  PCN 194-2016 Dulaglutide for the management of Type 2 diabetes
       
    Exenatide
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    Formulary
    Green

    Injection (Byetta®), 2mg Prefilled Pen m/r (Bydureon®)

  • Indication - Type 2 diabetes (in line with NICE criteria for initiation and continuation).

     
  • Link  MHRA Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
    Link  Drug Safety Update 03/2009 - Exenatide (Byetta ¥): risk of severe pancreatitis and renal failure
    Link  NICE TA248 Exenatide prolonged-release suspension for injection in combination with oral antidiabetic therapy for the treatment of type 2 diabetes
       
    Liraglutide (Victoza®)
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    Formulary
    Green

    Injection 6mg/ml

    • Indication - Type 2 Diabetes
     
    Link  MHRA Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
    Link  NICE NG28 Type 2 diabetes in adults: management
       
    Lixisenatide
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    Formulary
    Green

    Injection

    • Indication - Diabetes (type 2)
    • Consider adding a GLP-1 mimetic 3rd line therapy when control of blood glucose remains or becomes inadequate. Only continue if beneficial metabolic response.
     
    Link  MHRA Drug Safety Update Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
    Link  NICE NG28 - Type 2 diabetes in adults: management
    Link  PCN 73-2013 Lixisenatide for the treatment of type 2 diabetes mellitus
       
    Semaglutide (Ozempic®)
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    Formulary
    Green

    Injection 0.25mg/0.19ml, 0.5mg/0.37ml, 1mg/0.74ml pre-filled pen

    • Indication - Diabetes (type 2)

    Not Approved for use in type 2 diabetic patients with inadequate glucose control despite lifestyle intervention and metformin if they have 9 of 9 established cardiovascular disease in accordance with joint ADA/EASD clinical practice guidelines

     

    Surrey Area Precribing Committee (SAPC) have recommended this as BLACK on their formulary. APC 456-2019

     
    Link  APC 456-2019 Semaglutide (Ozempic®) for treatment of adults with insufficiently controlled type 2 diabetes mellitus
    Link  MHRA Drug Safety Update Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
       
    06.01.02.03  Expand sub section  SGLT2 inhibitors
    Canagliflozin (Invokana)
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    Third Choice
    Green

    Tablets

    • Indication - Diabetes (type 2)
    • Canagliflozin - an option for dual or triple therapy in type 2 diabetes.
    • Monotherapy as per NICE TA390 Only if:
      •a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
      •a sulfonylurea or pioglitazone is not appropriate.
     
    Link  MHRA Drug Safety Alert Feb 2019 SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
    Link  MHRA Druf Safety Update Apr 2016 SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
    Link  MHRA Drug Safety Update Jun 2016 Canagliflozin (Invokana¥, Vokanamet¥): signal of increased risk of lower extremity amputations observed in trial in high cardiovascular risk patient
    Link  MHRA Drug Safety Update June 2015 SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis
    Link  MHRA Drug Safety update Mar 2017 SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes)
    Link  NICE TA315 - Canagliflozin in combination therapy for treating type 2 diabetes
    Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
    Link  PCN 121-2014 Canagliflozin for the treatment of type 2 diabetes
       
    Dapagliflozin (Forxiga)
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    Third Choice
    Green

    Tablets

    • Indication - Type 2 diabetes (combination therapy, in line with NICE criteria for initiation and continuation)
    • Monotherapy as per NICE TA390 Only if:
      •a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
      •a sulfonylurea or pioglitazone is not appropriate.
    • Triple therapy regimen is recommended as an option for
      treating type 2 diabetes in adults, only in combination with metformin and a sulfonylurea.TA418

    Blue

    • Indication - With insulin for treating type 1 diabetes
     
    Link  NICE TA597 - Dapagliflozin with insulin for treating type 1 diabetes
    Link  MHRA Drug Safety Alert Feb 2019 SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
    Link  MHRA Drug Safety Update Apr 2016 SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
    Link  MHRA Drug Safety Update June 2015 SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis
    Link  NICE TA288 - Dapagliflozin in combination therapy for treating type 2 diabetes
    Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
    Link  NICE TA418- Dapagliflozin in triple therapy for treating type 2 diabetes- Nov 2016
    Link  PCN 72-2013 Dapagliflozin for the treatment of type 2 diabetes mellitus
       
    Empagliflozin (Jardiance▼®)
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    Formulary
    Green
    Tablets
  • Combinations therapy as per NICE TA336
  • Monotherapy as per NICE TA390 Only if:
    •a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
    •a sulfonylurea or pioglitazone is not appropriate.
     
  • Link  MHRA Drug Safety Alert Feb 2019 SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
    Link  MHRA Drug Safety Update April 2016 SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
    Link  MHRA Drug Safety Update June 2015 SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis
    Link  NICE TA336 Empagliflozin in combination therapy for treating type 2 diabetes
    Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
       
    Ertugliflozin (Steglatro®)
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    Formulary
    Green

    Tablets

    Indication - Type 2 diabetes in adults as per NICE TA572

    Monotherapy when metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control, only if:

    • a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
    • a sulfonylurea or pioglitazone is not appropriate.

    Dual-therapy in combination with metformin, only if:

    • a sulfonylurea is contraindicated or not tolerated or
    • the person is at significant risk of hypoglycaemia or its consequences

    Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes TA583

    • the disease is uncontrolled with metformin and a DPP‑4 inhibitor, and a sulfonylurea or pioglitazone is not appropriate.

     
    Link  APC 405 - 2019 Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes (NICE TA572)
    Link  NICE TA572 Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes
    Link  NICE TA583 Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes
       
    06.01.02.03  Expand sub section  Other
    06.01.02.05  Expand sub section  Glucagon-like peptide-1 receptor agonists - once weekly
    06.01.02.07  Expand sub section  Other antidiabetic drugs to top
    06.01.03  Expand sub section  Diabetic ketoacidosis
     note  In patient procedures vary, please see local hospital policy
    06.01.04  Expand sub section  Treatment of hypoglycaemia
    Glucagon 1mg powder and solvent (GlucaGen® HypoKit)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Injection

     
    Glucose 40% oral gel  (GlucoGel®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Glucose Oral Gel 3 x 25g

     
    Glucose powder
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
     
       
    06.01.04  Expand sub section  Chronic hypoglycaemia
     note  Diazoxide is useful for the management of patients with chronic hypoglycaemia from excess endogenous insulin secretion, either from an islet cell tumour or islet cell hyperplasia. It has no place in the management of acute hypoglycaemia.
    Diazoxide
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    Formulary
    Red

    Funded by NHS England via specialist centres

    CCGs commission ongoing prescription of drugs suitable for shared care


    Suspension 250mg / 5ml

    • Indication To treat Infants and Children with Congenital Hyperinsulinaemia, in combination with Chlorothiazide
      unlicensedunlicensed
    • CPMAP agreed RED June 2017
     
       
    06.01.05  Expand sub section  Treatment of diabetic nephropathy and neuropathy
     note  See BNF Chapter 6.6.5 - Diabetic nephropathy
    https://www.medicinescomplete.com/mc/bnf/current/PHP4233-diabetic-nephropathy.htm

    *Guidelines for Painful Diabetic Neuropathy* agreed by CPMAP June 2017
    06.01.05  Expand sub section  Diabetic nephropathy to top
    06.01.05  Expand sub section  Diabetic neuropathy
    06.01.06  Expand sub section  Diagnostic and monitoring agents for diabetes mellitus
    Continuous Glucose Monitors (CGM) and consumables
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
     
    Link   APC 416-2019 Real time Continuous Glucose Monitoring (rtCGM) for use in pregnant patients with type 1 Diabetes
    Link  APC 415-2019 Real time Continuous Glucose Monitoring (rtCGM) for use in children and young people (up to the age of 18) with type 1 Diabetes
    Link  APC 414-2019 Real time Continuous Glucose Monitoring (rtCGM) for use in adult patients (≥18 years of age) with type 1 Diabetes
    Link  PCN June 2018 - Position statement: Continuous glucose monitoring systems
    Link  PCN 335-2018 Continuous Glucose Monitors (CGM) and consumables
       
    06.01.06  Expand sub section  Blood glucose monitoring
     note  Formulary recommendations are based on cost effectiveness. Other brands of test strips are considered non-formulary although may be continued if appropriate for existing patients.
    Accu-check Performa Test Strips
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    Formulary
    Green
  • Test strips for use with Performa Nano blood glucose meter.
     
  • Link  Medical Device Alerts issued in April 2018; recent alert about Accu-Chek blood glucose test strips
       
    Blood Glucose Test Strips & associated meters
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    Formulary
    Green
    • A preferred list of cost-effective blood glucose meters and the associated test strips have been added onto the formulary. However, there is an exception criteria for certain patients (See excluded group below).
    • The selected meters (which meet ISO 15197:2013 requirements) to be included on the preferred list are:
      o GlucoMen Areo Sensor
      o Contour/ Contour Plus (Bayer)
      o Wavesense Jazz
      o Wavesense Jazz Duo
      o Omnitest 3 (Braun)
      o MyLife Pura
      o MyLife Unio
      o GlucoRx Nexus now the preferred speaking meter - suitable for patients with visual impairment
    • CareSens Pro Blood Glucose strips added to the formulary to enable the patient to have one meter to test both glucose and ketones (CareSens dual meter)
    • Or any meter that meets the above requirements with a test strip cost <£10 for 50
    • (Supercheck2 test strips and meter have been discontinued)
    • Exclusion group- patients remaining outside the scope of this work are specialist patient groups with specific clinical needs that are not met with the meters on the proposed formulary including:
       Patients with gestational diabetes
       Unstable type 1 diabetic patients who require ketone testing
       Patients who are carbohydrate counting
       Patients on insulin pumps
       Patients with severe manual dexterity problems who cannot use the meters on the preferred list.
    • Where a specialist has recommended a meter not on the preferred list, the specialist should communicate to the GP the clinical reasons why the preferred meters are not suitable. In these cases prescribing of other meters should be supported.
    • It is recommended that new patients should be started on meters on the preferred list and an informed switch programme should be initiated at routine review of existing patients (who are currently prescribed test strips costing >£10 and where a cost effective formulary meter would be clinically appropriate).
    • Meters are not prescribable on the NHS
    • Company representative contacts for obtaining meters free of charge are included in the link below (Preferred blood glucose meters and strips)

    Black

    • Freestyle Optium Blood Glucose test strip - Providing a dual meter (blood glucose and ketones) to patients is sufficient, regardless of if the patient uses the Freestyle Libre system
     
    Link  Brighton APC Blood Glucose Meters & Test Strips
    Link  Preferred blood glucose meters and strips Crawley CCG, Horsham and Mid-Sussex CCG
       
    Flash Glucose Monitoring (FreeStyle Libre)
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    Formulary
    Blue

    Approved for prescribing from 1 April 2019 in line with NHS England criteria only.

    Commencement must be within diabetes specialist led clinic.

    Patients should not be referred specifically for the initiation of flash glucose monitoring. Eligibility is expected to be assessed during routine consultations with specialist as part of the patient's annual diabetes review or a review that takes place as a result of other changes in their diabetic needs.

    Indications

    • People with Type 1 diabetes

    OR with any form of diabetes on hemodialysis and on insulin treatment

    who, in either of the above, are clinically indicated as requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past 3 months

    OR with diabetes associated with cystic fibrosis on insulin treatment

    • Pregnant women with Type 1 Diabetes - 12 months in total inclusive of post-delivery period.
    • People with Type 1 diabetes unable to routinely self-monitor blood glucose due to disability who require carers to support glucose monitoring and insulin management.
    • People with Type 1 diabetes for whom the specialist diabetes MDT determines have occupational (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick testing) or psychosocial circumstances that warrant a 6-month trial of Libre with appropriate adjunct support.
    • Previous self-funders of Flash Glucose Monitors with Type 1 diabetes where those with clinical responsibility for their diabetes care are satisfied that their clinical history suggests that they would have satisfied one or more of these criteria prior to them commencing use of Flash Glucose Monitoring had these criteria been in place prior to April 2019 AND has shown improvement in HbA1c since self-funding. 
    • For those with Type 1 diabetes and recurrent severe hypoglycemia or impaired awareness of hypoglycemia, NICE suggests that Continuous Glucose Monitoring with an alarm is the standard. Other evidence-based alternatives with NICE guidance or NICE TA support are pump therapy, psychological support, structured education, islet transplantation and whole pancreas transplantation. However, if the person with diabetes and their clinician consider that a Flash Glucose Monitoring system would be more appropriate for the individual’s specific situation, then this can be considered.

    Other requirements:

    1. Education on Flash Glucose Monitoring has been provided (online or in person)

    2. Agree to scan glucose levels no less than 8 times per day and use the sensor >70% of the time.

    3. Agree to regular reviews with the local clinical team.

    4. Previous attendance, or due consideration given to future attendance, at a Type 1 diabetes structured education programme (DAFNE or equivalent if available locally)

    Note: Continuing prescription for long-term use of Flash Glucose Monitoring-post initial 6 months- would be contingent upon evidence of agreeing with the above conditions and that on-going use of the Flash Glucose Monitoring is demonstrably improving an individual’s diabetes self-management- for example improvement of HbA1c or Time In Range; improvement in symptoms such as DKA or hypoglycaemia; or improvement in psycho-social wellbeing.

     
    Link  APC 404-2019 (replaces PCN 281 – 2017)Flash Glucose Monitoring System (FGS) for patients (over 4 years of age)
    Link  Flash Glucose Monitoring – Frequently Asked Questions for Commissioners
    Link  Flash Glucose Monitoring (FGM): Continuation Agreement for Adults
    Link  Flash Glucose Monitoring (FGM): Initiation and Transfer Agreement for Adults
    Link  Flash Glucose Monitoring (FGM): Initiation and Transfer Agreement for Paediatrics
    Link  Flash Glucose Monitoring (FGM): Continuation Agreement for Paediatrics
       
    06.01.06  Expand sub section  Urinalysis
    Ketones test strips (Ketostix ®)
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    First Choice
    Green
  • For detection of ketones in urine
  •  
    06.01.06  Expand sub section  Blood Ketones Testing Strips to top
    Blood Ketone Test Strips and associated meters
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    Formulary
    Blue
    • A preferred list of cost-effective blood ketone meters and the associated test strips have been added onto the formulary.
    • GlucoMen areo Ketone sensors (Menarini)
    • KetoSens ketone test strips (Spirit)

    Both test strips are £9.95 per 10 strips and have shelf life of 18mths

    Black

    • Freestyle Optium Ketone Test Strips - providing a dual meter (blood glucose and ketones) to patients is sufficient regardless of if the patient uses the Freestyle Libre system.
    • Prescribers are advised that they may continue to prescribe only to paediatric patients who are currently using this product so that the  specialist providers at Royal Alexandra Children’s Hospital have time to  transition them onto a new product in line with formulary choices.
     
       
    06.02  Expand sub section  Thyroid and Antithyroid drugs
    06.02.01  Expand sub section  Thyroid hormones
    Levothyroxine
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    First Choice
    Green

    Tablets

    • NOTE, TEVA 12.5mg strength tablets are significantly more expensive than the other strengths, therefore it is more cost effective to use half of a 25mg strength if needed.

     

    If Lactose-free is required

    TEVA brand (Lactose Free) - GP would need to stipulate on the prescription when prescribing that the "patient requires lactose free and TEVA brand to be supplied". This can be done as a pharmacy note on prescription.

     
    Liothyronine (T3)
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    Formulary
    Red

    Indication-

    • Following thyroidectomy where a patient requires liothyronine until radioactive iodine is no longer indicated (PCN 186-2016)
    • Treatment of coma of myxoedema (APC 408-2019)
    • Severe chronic thyroid deficiency and hypothyroid states occurring in the treatment of thyrotoxicosis (APC 409-2019)
    • Treatment of resistant depression (APC 410-2019)
    • Liothyronine monotherapy in oncology - thyroid and parathyroid disease (APC 421-2019)
    • Liothyronine sodium (monotherapy) - Hypothyroidism in adults with an intolerance to levothyroxine. Please note the Crawley, Horsham and Mid-Sussex CCG decision is RED and differs from the Surrey APC decision of AMBER. (APC 412-2019)
    • Liothyronine sodium (combination) - Hypothyroidism in adults with an inadequate response to levothyroxine. Please note the Crawley, Horsham and Mid-Sussex CCG decision is RED and differs from the Surrey APC decision of AMBER. (APC 411-2019)
     
    Link  APC 412-2019 (Replaces PCN197-2016 & PCN378-2018) Liothyronine sodium (monotherapy) - Hypothyroidism in adults with an intolerance to levothyroxine
    Link  APC 411-2019 (replaces PCN198-2016 & PCN378-2018) Liothyronine sodium (combination) - Hypothyroidism in adults with an inadequate response to levothyroxine
    Link  APC 410-2019 (replaces PCN195-2019) Liothyronine (T3) for treatment resistant depression in adults
    Link  APC 409-2019 (replaces PCN191-2016) Liothyronine (T3) in the management of hypothyroid states occurring in the treatment of thyrotoxicosis.
    Link  APC 408-2019 (replaces PCN190-2016) Liothyronine (T3) for the treatment of myxoedema coma
    Link  APC 421-2019 (replaces PCN 379 – 2018) Liothyronine monotherapy in oncology – thyroid and parathyroid disease
    Link  PCN 186-2016 Liothyronine for patients post thyroidectomy
       
    06.02.02  Expand sub section  Antithyroid drugs
     note  Neutropenia and agranulocytosis - Doctors are reminded of the importance of recognising bone marrow suppression induced by carbimazole and the need to stop treatment promptly. Patient should be asked to report symptoms and signs suggestive of infection, especially sore throat. A white blood cell count should be performed if there is any clinical evidence of infection. Carbimazole should be stopped promptly if there is clinical or laboratory evidence of neutropenia.
    06.03  Expand sub section  Corticosteroids
     note  MHRA Drug Safety Update Aug 2017 - Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration

    Patients on long-term corticosteroid treatment should carry a Steroid Treatment Card which gives guidance on minimising risk and provides details of prescriber, drug, dosage and duration of treatment.

    Steroid treatment cards

    Steroid treatment cards (see Steroid Treatment Card) should be issued where appropriate, and are available for purchase from:

    3M Security Print and Systems Limited
    Gorse Street,
    Chadderton
    Oldham
    OL9 9QH
    Tel: 0845 610 1112

    GP practices can obtain supplies through their Local Area Team Stores.

    06.03.01  Expand sub section  Replacement therapy to top
    Fludrocortisone
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    Formulary
    Green

    Tablets
  • Indications - Mineralocorticoid replacement in adrenocortical insufficiency. 
  •    
    06.03.02  Expand sub section  Glucocorticoid therapy
    06.03.02  Expand sub section  Disadvantages of corticosteroids
    06.03.02  Expand sub section  Use of corticosteroids
    06.03.02  Expand sub section  Pregnancy and breastfeeding
    06.03.02  Expand sub section  Administration to top
    06.03.02  Expand sub section  Withdrawal of corticosteroids
    06.04  Expand sub section  Sex hormones
     note  Gender dysphoria in adults and children - pharmacological treatment in primary care. CPMAP August 2017 the panel noted the guidelines below are useful documents but the share care agreements are unclear. The panel decided that individual drugs could be considered as AMBER but individual clinicians would make their own decision as to whether to prescribe until a clear shared care agreement was in place.

    MCG 04/2017 - Gender dysphoria in adults and children – pharmacological treatment in primary care

    WLMH Prescribing Guidance - Gender dysphoria Male to Female 

    WLMH Prescribing Guidance - Gender dysphoria Female to Male
    06.04.01  Expand sub section  Female sex hormones and their modulators
    06.04.01.01  Expand sub section  Oestrogens and HRT
     note 

    NICE NG23 Nov 2015 Menopause: diagnosis and management

    MHRA Drug Safety Update Aug 2019 Hormone replacement therapy (HRT): further information on the known increased risk of breast cancer with HRT and its persistence after stopping

    Combined Continuous HRT tablet  (Kliovance® )
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    First Choice
    Green

    Tablets

    Estradiol with Progestogen
  • Estradiol/northisterone
  • Continous Combined therapy - for women with a uterus


  •  
    Combined Continuous HRT tablet  (Premique®)
    (Low Dose)
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Tablets


    Conjugated Oestrogens with Progestogen
  • Conjugated oestrogens/medroxyprogesterone
  • Continous Combined therapy - for women with a uterus
  • Oestrogen derived from equine source
  •  
    Combined Cyclical HRT tablet  (Elleste-Duet® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Tablets
    Estradiol with Progestogen

    • 16 x estradiol, 12 x estradiol/northisterone
    • Sequential Combined therapy - for women with a uterus
    • Courses repeated without interval

     

     
    Femoston®
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    First Choice
    Green

    Tablets

    Estradiol with Progestogen
  • For women with a Uterus

  •  
    Oestrogens for HRT (Elleste-Solo®)
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    First Choice
    Green
    Tablets

    Estradiol only
  • Estradiol
  • Unopposed Oestrogen - for women without a uterus
  •  
    Combined Continous HRT patch  (Evorel Conti® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green

    Patches

    Estradiol with Progestogen
  • Estradiol/northisterone
  • Only prescribe patches for patients with liver impariment or compliance issues
  • Continuous Combined therapy - for women with a uterus

  •  
    Link  MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
       
    Combined Continuous HRT tablet  (Kliofem® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green

    Tablets

    Estradiol with Progestogen
  • Estradiol/northisterone
  • Continous Combined therapy - for women with a uterus
  •  
    Link  MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
       
    Combined Cyclical HRT patch  (Evorel Sequi® )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green

    Patches

    Estradiol with Progestogen
  • 4 x estradiol, 4 x estradiol/northisterone
  • Only prescribe patches for patients with liver impairment or compliance issues
  • Sequential Combined therapy - for women with uterus
  • Courses repeated without interval
  •  
    Link  MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
       
    Oestrogen only HRT patch  (Evorel®)
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    Second Choice
    Green

    Patches

    Estradiol only
  • Estradiol
  • Only prescribe patches for patients with liver impairment or compliance issues
  • Unopposed Oestrogen - for women without a uterus
  •  
    Link  MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
       
    Oestrogen only HRT tablet  (Premarin®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green

    Tablets Conjugated oestrogens

    Conjugated Oestrogens only
  • Conjugated oestrogens
  • Unopposed Oestrogen - for women without a uterus
  • Oestrogen derived from equine source
  •  
    Link  MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
       
    Oestrogens for HRT (Elleste-Solo® MX)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green
    Patches

    Estradiol only
  • Women without uterus
  •  
    Link  MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
       
    Tibolone (Livial®)
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    Second Choice
    Green

    Tablets

  • Tibolone has oestrogenic, progestogenic and weak androgenic activity
  •  
    Link  MHRA Drug Safety Update Feb 2009 Tibolone: increased risk of breast cancer recurrence
    Link  MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
       
    06.04.01.01  Expand sub section  Hormone replacement therapy to top
     note 


    Oestrogens are no longer used to suppress lactation because of their association with thromboembolism. The minimum effective dose of HRT should be used for the shortest duration. The choice of HRT for an individual depends on an overall balance of indication, risk and convenience. An oestrogen alone is suitable for continuous use in women without a uterus. However, in endometriosis, endometrial foci may remain despite hysterectomy and the addition of a progestogen should be considered in these circumstances.

    06.04.01.01  Expand sub section  Ethinylestradiol
    Ethinylestradiol
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue

    Tablets 
    Link  MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
       
    06.04.01.01  Expand sub section  Raloxifene
    Raloxifene Hydrochloride (Evista®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Second Choice
    Green

    Tablets
  • Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women TA160
  • Raloxifene for the secondary prevention of osteoporotic fragility fractures in postmenopausal women TA161

  • Blue
  • Indication - Chemoprevention for women at moderate to high risk of breast cancer

    Black
  • Indication - Osteoporosis - primary prevention. 
  • Link  NICE CG164 Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer
    Link  NICE TA160 - Updated 2/2018 - Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women
    Link  NICE TA161 - Updated 7-2-18 - Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
       
    06.04.01.02  Expand sub section  Progestogens
     note 

    Where endometriosis required drug treatment, it may respond to a progestogen adminstered on a continuous basis. Danazol and gonadorelin analogues are also available.

    Although oral progestogens have been widely used for menorrhagia they are relatively ineffective compared with tranexamic acid or, particularly where dysmenorrhoea is also a factor mefenamic acid.

    Oral progestogens have also been used for severe dysmenorrhoea, but where contraception is also required in younger women the best choice is a combined oral contraceptive.

    Progestogens have also been advocated for the alleviation of premenstrual symptoms, but no convincing physiological basis for such treatment has been shown.

    Progestogens have been used for the prevention of miscarriage in women with a history of recurrent miscarriage but there is no evidence of benefit and they are not recommended for this purpose.

    Medroxyprogesterone Acetate
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Tablets 
    Norethisterone
    View adult BNF View SPC online View childrens BNF  Track Changes
    First Choice
    Green

    Tablets
     
    Progesterone (Cyclogest®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue

    Pessaries 
       
    Progesterone (Utrogestan®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    Capsules 
       
    06.04.02  Expand sub section  Male sex hormones and antagonists
    06.04.02  Expand sub section  Anti-androgens to top
     note 

    Androgens are used for replacement therapy in hypogonadal males but will not restore fertility or relieve impotence in men with normal testosterone levels. In the normal male they suppress pituitary gonadotrophins and spermatogenesis.

    Androgens cause masculinisation; they may be used as replacement therapy in castrated adults and in those who are hypogonadal due to either pituitary or testicular disease.

    Androgens are useless as a treatment of impotence and impaired spermatogenesis unless there is associated hypogonadism; they should not be given until the hypogonadism has been properly investigated.

    06.04.02  Expand sub section  Dutasteride and finasteride
    06.04.03  Expand sub section  Anabolic steroids
     note  The protein-building properties of anabolic steroids have not proved benficial in a clinical setting. Their use as body builders or tonics is unjustified. Some athletes may abuse them.
    06.05  Expand sub section  Hypothalamic and pituitary hormones and anti-oestrogens
    06.05.01  Expand sub section  Hypothalamic and anterior pituitary hormones and anti-oestrogens
     note 

    Fertility guidelines

    06.05.01  Expand sub section  Anti-oestrogens to top
     note  For women who are taking clomifene citrate, offer ultrsound monitoring during at least the first cycle of treatment to ensure that they are taking a dose that minimises the risk of multiple pregnancy.
    The Committee on Safety of Medicines has recommended that clomifene should not normally be used for longer than 6 months.
    Clomifene Citrate
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    Formulary
    Red

    Tablets
  • Indication - Fertility treatment - Clomiphene only

    Blue Traffic Light
  • There are specialist GPs who prescribe under a commissioned Primary Care Fertility Service. In this case all prescribing and monitoring will be undertaken by the specialist GP from the service. 
  •    
    06.05.01  Expand sub section  Anterior pituitary hormones
     note  PRODIGY recommends that in most cases, the diagnosis of Addison's disease in adults should be confirmed in secondary care, as this reflects expert opinion from the Addison's Clinical Advisory Panel.
    Risk of anaphylaxis requires medical supervision.
    Somatropin ( Omnitrope SurePal®)
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    First Choice
    Blue

    Injection Cartridge

    • Funded by CCG
    • Indications
    • Prader Willi Syndrome/Turners Syndrome
    • Growth Hormone Deficiency in adults
    • Omnitrope and SurePal pen device free from company (Sandoz Ltd). (NOT prescribable on NHS)
    • Statement from BSUH Paediatric Endocrinologists‘Omnitrope and Genotropin to be considered as 1st line options in children (with the understanding that other devices are still offered as required to allow patient needs and patient choice to be met).’
     
    Somatropin (Genotropin ®)
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    First Choice
    Blue
    Injection (for use with Genotropin® Pen), Go Quick® Injection, MiniQuick® Injection
  • Funded by CCG
  • Indications
  • Prader Willi Syndrome/Turners Syndrome
  • Growth Hormone Deficiency in adults

  • Statement from BSUH Paediatric Endocrinologists‘Omnitrope and Genotropin to be considered as 1st line options in children (with the understanding that other devices are still offered as required to allow patient needs and patient choice to be met).’ 
  • Somatropin (Humatrope®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
    Injection
  • Funded by CCG
  • Indications
  • Prader Willi Syndrome/Turners Syndrome
  • Growth Hormone Deficiency in adults
  •  
    Link  Growth hormone deficiency (adults) - human growth hormone (TA64)
    Link  Human growth hormone (somatropin) for the treatment of growth failure in children (review) (TA188)
    Link  APC 2016- Information sheet- Human Growth Hormone in Adults- Aug 2016
    Link  APC 2016- Information sheet- Human Growth Hormone in Children- Aug 2016
       
    Somatropin (Norditropin® SimpleXx )
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
    Injection
  • Funded by CCG
  • Indications
  • Prader Willi Syndrome/Turners Syndrome
  • Growth Hormone Deficiency in adults
  •  
    Link  Growth hormone deficiency (adults) - human growth hormone (TA64)
    Link  Human growth hormone (somatropin) for the treatment of growth failure in children (review) (TA188)
    Link  APC 2016- Information sheet- Human Growth Hormone in Adults- Aug 2016
    Link  APC 2016- Information sheet- Human Growth Hormone in Children- Aug 2016
       
    Somatropin (Saizen® Saizen Click.easy ®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue
    Injection
  • Funded by CCG
  • Indications
  • Prader Willi Syndrome/Turners Syndrome
  • Growth Hormone Deficiency in adults
  •  
    Link  Growth hormone deficiency (adults) - human growth hormone (TA64)
    Link  Human growth hormone (somatropin) for the treatment of growth failure in children (review) (TA188)
    Link  APC 2016- Information sheet- Human Growth Hormone in Adults- Aug 2016
    Link  APC 2016- Information sheet- Human Growth Hormone in Children- Aug 2016
       
    06.05.01  Expand sub section  Gonadotrophins
    06.05.01  Expand sub section  Growth Hormone
    06.05.01  Expand sub section  Growth hormone receptor antagonists
    06.05.01  Expand sub section  Thyrotropin to top
    06.05.01  Expand sub section  Hypothalmic hormones
    06.05.02  Expand sub section  Posterior pituitary hormones and antagonists
    06.05.02  Expand sub section  Posterior pituitary hormones
    06.05.02  Expand sub section  Antidiuretic hormone antagonists
    06.06  Expand sub section  Drugs affecting bone metabolism to top
    06.06  Expand sub section  Osteoporosis
    06.06.01  Expand sub section  Calcitonin and parathyroid hormone
    Teriparatide (Forsteo®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection 250 micrograms/ml
  • Funded by CCG (women), Funded by NHS England (men)
  • Indication - Osteoporosis - primary prevention.
  • for the secondary prevention of osteoporotic fragility in postmenopausal women TA161 
  • Link  NICE TA161 - updated 7/2/18 - Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
    Link  PCN Statement 05/2014 - Osteoporosis guideline update
    Link  Treatment Guidelines for Osteoporosis in Adults - Nov 17
       
    06.06.02  Expand sub section  Bisphosphonates and other drugs affecting bone metabolism
    06.06.02  Expand sub section  Bisphosphonates
     note  Patients at risk of osteoporosis should maintain an adequate intake of calcium and vitamin D and any deficiency should be corrected by increasing dietary intake or taking supplements.

    MHRA/CHM advise that due to the risk of atypical femoral fractures the need to continue bisphosphonate treatment for osteoporosis should be re-evaluated periodically based on an assesment of the benefits and risks of treatment for individual patients, particularly after 5 years or more of use. Patients should be advised to report any thigh, hip or groin pain during treatment.

    Bisphosphonates and risks of osteonecrosis of the jaw - All patients should have a dental check-up before commencing treatment and prescribers should consider risk factors before initiation. Good oral hygiene should be maintained during treatment.

    06.06.02  Expand sub section  Denosumab to top
    06.06.02  Expand sub section  Strontium renelate
    06.07  Expand sub section  Other endocrine drugs
    06.07.01  Expand sub section  Bromocriptine and other dopaminergic drugs
    Bromocriptine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue

    Tablets, Capsules 
    Link  MHRA Drug safety update Oct 2008 Ergot-derived dopamine agonists: risk of fibrotic reactions in chronic endocrine uses
    Link  Safety review, the European Medicines Agency (EMA) - Bromocriptine
       
    Cabergoline
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue

    Tablets 
    Link  MHRA Drug safety update Oct 2008 Ergot-derived dopamine agonists: risk of fibrotic reactions in chronic endocrine uses
       
    Quinagolide (Norprolac®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Blue

    Tablets 75 micrograms, Starter pack
  • Indication - Hyperprolactinaemia 
  •    
    06.07.02  Expand sub section  Drugs affecting gonadotrophins
    06.07.02  Expand sub section  Gonadorelin analogues to top
    06.07.02  Expand sub section  Breast pain (mastalgia)
    06.07.03  Expand sub section  Metyrapone
    06.07.04  Expand sub section  Somatomedins
     ....
     Non Formulary Items
    Acarbose  (Glucobay®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Albiglutide  (Eperzan®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Alogliptin / metformin  (Vipdomet®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Alogliptin / pioglitazone  (Incresync®)

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Biphasic Isophane Insulin  (Hypurin® Porcine 30/70 Mix)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Biphasic Isophane Insulin  (Insuman® Comb)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary Temporary shortage supply of Insulin human - INSUMAN® Comb 25.
    No new patients should be started on Insuman® Comb 25(prefilled pens and cartridges) during the shortage and existing patients should be switched to a suitable alternative. (see link below)
    Shortage also affects INSUMAN® Basal(prefilled pens and cartridges)

    Link  EMEA Shortage of Insuman Basal and Comb 25 (insulin human)
    Link  Sanofi letter Shortage of Insuman Basal and Comb 25
     
    Biphasic Isophane Insulin  (Mixtard® 30)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Calcitonin (salmon) / Salcatonin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Calcitonin (salmon) / Salcatonin

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Canagliflozin / metformin IR  (Vokanamet®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Link  MHRA Drug Safety update Mar 2017 SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes)
     
    Chlorpropamide

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Choriogonadotropin Alfa  (Ovitrelle®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Chorionic Gonadotrophin  (Choragon®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Combination test strips

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Combined Cyclical HRT tablet  (Prempak-C®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Green

    Tablets

    DISCONTINUED 01/2017

    Conjugated Oestrogens with Progestogen

    • 28 x conjugated oestrogens, 12 x norgestrel
    • Sequential Combined therapy - for women with a uterus
    • Courses repeated without interval
    • 150 mcg norgestrel ≡ 75 mcg levonorgestrel
    • Oestrogen derived from equine source
    Link  MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
     
    Conjugated oestrogens and bazedoxifene  (Duavive®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

     0.45 mg/20 mg modified-release tablets

    • Treatment of oestrogen deficiency symptoms in postmenopausal women with a uterus (with at least 12 months since the last menses) for whom treatment with progestin-containing therapy is not appropriate.

    Patients currently taking Duavive should be reviewed and switched to an alternative preparation.

    Product being withdrawn from the market by Dec 2019

    Link  PCN 428-2019 Duavive (conjugated oestrogens & bazedoxifene) for the treatment of oestrogen deficiency symptoms in postmenopausal women
     
    Corifollitropin Alfa  (Elonva®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dapagliflozin / metformin  (Xigduo®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Diazoxide  (Eudemine®)

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dydrogesterone  (Duphaston®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dydrogesterone  (Duphaston® HRT)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Follitropin Alfa  (Gonal-F®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Follitropin Alfa and Beta  (Puregon®)

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Glibenclamide  (Daonil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Glibenclamide  (Euglucon®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Glibenclamide  (Semi-Daonil®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Gliquidone  (Glurenorm®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Glucose  (Clinistix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Glucose  (Clinitest®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Glucose  (Diabur-Test® 5000)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Glucose  (Diastix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Glucose test strips

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Gonadorelin  (HRF®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Human Menopausal Gonadotrophins  (Menogon®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Human Menopausal Gonadotrophins  (Menopur®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Injection Devices  (HumaPen® Ergo)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Injection Devices  (mhi-500®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Injection Devices  (NovoPen®3 Demi)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary For use with Novo Nordisk 3ml cartridges

    DISCONTINUED
     
    Injection Devices  (OptiPen Pro 1®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Injection Devices  (SQ-PEN®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Insulin  (Exubera®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Insulin  (Humulin® S)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Insulin  (Insuman® Rapid)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Insulin  (Pork Actrapid®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Insulin  (Velosulin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Insulin bovine  (Hypurin® Bovine Neutral)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    All the latest information about the discontinuation of bovine insulin can be found on the Wockhardt website: http://www.wockhardt.co.uk/our-products/bovine-insulin-patient-information.aspx

     
    Insulin degludec and liraglutide  (Xultophy®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
    Restricted Item Black Triangle
    Link  MHRA Drug Safety Update 29/04/2015 - High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error
    Link  PCN 183-2016 statement Xultophy (insulin degludec/liraglutide)
     
    Insulin degludec with insulin aspart

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
  • Approved but not launched in UK
  •  
    Insulin porcine  (Hypurin® Porcine Neutral)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Insulin Zinc suspension  (Hypurin®Bovine Lente)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    All the latest information about the discontinuation of bovine insulin can be found on the Wockhardt website: http://www.wockhardt.co.uk/our-products/bovine-insulin-patient-information.aspx

     
    Isophane Insulin  (Hypurin® Bovine Isophane)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    All the latest information about the discontinuation of bovine insulin can be found on the Wockhardt website: http://www.wockhardt.co.uk/our-products/bovine-insulin-patient-information.aspx

     
    Isophane Insulin  (Hypurin® Porcine Isophane)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Isophane Insulin  (Pork Insulatard®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Ketones  (Ketur Test®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Linagliptin/ metformin  (Jentadueto®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Liothyronine (T3) and thyroid extracts

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Indication-

    • Management of ADULTS with hypothyroidism (either alone or in combination with T4 levothyroxine)

    The CCGs do not support the use of thyroid extracts (e.g. Armour thyroid, ERFA Thyroid), compounded thyroid hormones, iodine containing preparations, and dietary supplementation are not recommended. The prescribing of unlicensed liothyronine and thyroid extract products are not supported as the safety, quality and efficacy of these products cannot be assured.
     

    Link  APC 407-2019 (replaces PCN192-2016)t Unlicensed liothyronine and thyroid extract products:
    Link  PCN 378-2018 Patients currently receiving liothyronine monotherapy, Patients currently receiving liothyronine and levothyroxine combination therapy
    Link  NHS England guidance Items which should not routinely be prescribed in primary care
    Link  APC 25-2015 Liothyronine
    Link  Brighton Joint Formulary Not for routine prescribing (BLACK list)
    Link  The Royal College of Physicians -The Diagnosis and Management of Primary Hypothyroidism
     
    Liraglutide  (Saxenda®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Injection

    • Indication - Weight management in adult patients

    Primary care prescribers should not accept prescribing responsibility if asked to prescribe by private providers

    Link  MHRA Drug Safety Update Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
    Link  APC 386-2019 Liraglutide (Saxenda) for weight management
    Link  NICE NG28 - May 2017 - Type 2 diabetes in adults: management - replaces TA 203
     
    Lixivaptan

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
  • Indications
  • Growth Hormone
  • Growth Hormone Receptor Antagonist
  •  
    Lucozade®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Lutropin Alfa  (Luveris®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Medroxyprogesterone Acetate  (Climanor®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Metformin & pioglitazone  (Competact®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Metformin sachets  (Glucophage® SR)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary PRODUCT DISCONTINUED (both strengths)

    Sachets
     
    Norethisterone  (Primolut N®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogen only HRT implant  (Estradiol)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Angeliq®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Bedol®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Climagest®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Climaval®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Discontinued 01/2016
     
    Oestrogens for HRT  (Climesse®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Clinorette®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Cyclo-Progynova®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Estracombi®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Estraderm MX®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Estraderm TTS®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Estradiol®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Femapak®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Fematrix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (FemSeven®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (FemSeven® Conti)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (FemSeven® Sequi)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (FemTab®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (FemTab® Sequi)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Harmogen®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Hormonin®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary Discontinued 01/2016
     
    Oestrogens for HRT  (Indivina®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Menorin® 50)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Novofem®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Nuvelle®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Ovestin®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Progynova®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Progynova® TS)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Sandrena®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Tridestra®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Trisequens®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Zumenon®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oral glucose tolerance test.  (Rapilose® OGTT)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Parathyroid Hormone

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
  • Indication - Osteoporosis
  •  
    Pegvisomant  (Somavert®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black

    Vials for subcutaneous injection
  • Indication - Acromegaly

    Specialist drug. Trusts should apply to the CCG for funding via IFR.
  • Link  Brighton Joint Formulary Not for routine prescribing (BLACK list)
     
    Pioglitazone and Metfomin  (Competact®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Polycal®

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Progesterone  (Crinone®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Progesterone  (Gestone®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Protamine Zinc Insulin  (Hypurin® Bovine Protamine Zinc)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Protein  (Medi-Test® Protein 2)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Protein test strips  (Albustix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Protirelin  (TRH)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Rosiglitazone  (Avandia®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Rosiglitazone and Metformin  (Avandamet®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Saxagliptin and metformin  (Komboglyze®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sermorelin  (Geref 50®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sitagliptin and Metformin  (Janumet®)

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

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Black
  • Indication - HIV associated Lipodystrophy
  •  
    Test Strips  (Combur 9®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test Strips  (Combur5® )

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test Strips  (Combur7®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test Strips  (Diastix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test Strips  (Keto-Diastix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test Strips  (Multistix 10 SG®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test Strips  (Multistix 8SG®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test Strips  (Multistix SG®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test Strips  (Multistix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Tetracosactide  (Synacthen®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Thyrotropin Alfa  (Thyrogen®)

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Treatment of hypoglycaemia  (Rapilose® gel)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Urinalysis  (Clinitest®)

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

    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
    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

    Black

    Comment : Not to be routinely commissioned (prescribed) in any care setting (primary or secondary care). This may be due to a lack of good clinical evidence, cost effectiveness, concerns over safety or due to the availability of more suitable alternatives. As such, drugs classified as Black should be considered as non-formulary.   

    Red

    Initiation : Specialist only
    Repeat Prescribing : Specialist
    Monitoring : Specialist
    Comment : Prescribing must be in line with any specific treatment criteria outlined. In exceptional circumstances a GP may be asked to prescribe – the specialist must provide adequate information and support.   

    Amber

    Initiation : Specialist only
    Repeat Prescribing : Primary care OR specialist
    Monitoring : Primary care OR specialist
    Comment : Monitoring according to Effective Shared Care Agreement (ESCA) for stabilised patients only. GP agreement should be requested by specialist and confirmed/declined by GP on a patient-by-patient basis.   

    Blue

    Initiation/Recommendation : Specialist only
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Should be initiated or recommended by a specialist. Monitoring of either medicine or disease does not require specialist skills or equipment   

    Green

    Initiation : Primary care or specialist
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Suitable for non specialist initiation   

    OTC

    Patients should be advised to purchase if approriate.  

    netFormulary