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 Formulary Chapter 6: Endocrine system - Full Chapter
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06.01  Drugs used in diabetes
06.01.01  Insulins
 note 

Patients starting on insulin should receive an insulin passport; www.npsa/adult patient's passport to safer insulin use. A passport should be provided by the prescriber initiating treatment.

The NPSA issued an alert in June 2010 for the safer administration of insulin.

All patients starting on insulin must inform the DVLA and also their motor vehicle insurance company; https://www.gov.uk/diabetes-driving.

Insulins are available in a variety of vial, cartridge and pre-loaded pen presentations. Not all cartridges fit all pens.

Insulins should always be prescribed by brand name.

06.01.01.01  Short-acting insulins
06.01.01.01  Soluble Insulin
Actrapid®
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First Choice 10ml vial 
Humulin® S
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 3ml cartridge
10ml vial 
   
Insuman® Rapid
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Formulary 3ml cartridge (via ClikSTAR® or Autopen® 24)

 
   
Hypurin® Bovine Neutral
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Formulary 3ml cartridge (for Autopen® Classic)

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal insulin 
   
Hypurin® Porcine Neutral
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 3ml cartridge (for Autopen® Classic)

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal insulin 
   
06.01.01.01  Rapid Acting Insulin Analogues to top
Apidra® (Insulin Glulisine)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice 3ml cartridge (via ClikSTAR® or Autopen® 24)
3ml pre-filled disposable pen (SoloStar®)
 
Humalog® (Insulin Lispro)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice 3ml cartridge (via Autopen® Classic or HumaPen®)
3ml prefilled disposable pen (Kwikpen®)
 
NovoRapid® (Insulin Aspart)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 3ml cartridge (via Novopen® devices)
3ml prefilled disposable pen (Flexpen®)
 
   
06.01.01.02  Intermediate- and long-acting insulins
 note 

Any decision to commence an insulin analogue needs to be balanced carefully against the lack of long term safety data and increased prescribing costs (see NPC document ‘Key Therapeutic Topics’ for full information); http://www.npc.nhs.uk/qipp/resources/Key_therapeutic_topics_Medicines_Management_for_local_implementation_April_2012.pdf

The NICE guideline on type 2 diabetes; NICE CG87: Type 2 diabetes recommends that, when insulin therapy is necessary, human NPH (isophane) insulin (e.g. Insulatard®, Humulin I® or Insuman® Basal) is the preferred option. Long-acting insulin analogues have a role in some patients, and can be considered for those who fall into specific categories e.g. those who require assistance from a carer or healthcare professional to administer their insulin injections, or those with problematic hypoglycaemia. However, for most people with type 2 diabetes, long-acting insulin analogues offer no significant advantage over human NPH insulin and are much more expensive.

06.01.01.02  Biphasic insulins
Humulin® M3 (Biphasic Isophane Insulin )
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First Choice 3ml cartridge (via Humapen® Luxura device)
3ml prefilled disposable pen (Kwikpen®)
 
Insuman® Comb 25 (Biphasic Isophane Insulin)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice 3ml cartridge (via ClikSTAR® or Autopen®24 devices)
3ml prefilled disposable pen (Solostar®)
 
Insuman® Comb 15 (Biphasic Isophane Insulin)
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First Choice 3ml cartridge (via ClikSTAR® or Autopen®24 devices)
 
Insuman® Comb 50 (Biphasic Isophane Insulin)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice 3ml cartridge (via ClikSTAR® or Autopen®24 devices)
 
Humalog® Mix25 (Biphasic Insulin Lispro)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 3ml cartridge (via Humapen® Luxura device)
3ml prefilled disposable pen (Kwikpen® )

 
   
Humalog® Mix50 (Biphasic Insulin Lispro)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 3ml cartridge (via Humapen® Luxura device)
3ml disposable prefilled pen (Kwikpen®)
 
   
Hypurin® Porcine 30/70 Mix (Biphasic Isophane Insulin)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 3ml cartridge (for Autopen® Classic)

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal insulin
 
   
NovoMix® 30 (Biphasic Insulin Aspart)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 3ml cartridge (via Novopen® 4 device)
3ml prefilled disposable pen (Flexpen®)

 
   
06.01.01.02  Intermediate-acting Insulin
Insuman® Basal (Isophane Insulin)
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First Choice 3ml cartridge (via ClikSTAR® or Autopen®24 devices)
3ml prefilled disposable pen (Solostar®)
 
Insulatard® (Isophane Insulin)
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Formulary 3ml cartridge (via Novopen®4)
3ml prefilled disposable pen (Innolet®)
 
   
Humulin® I (Isophane Insulin)
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Formulary 3ml cartridge (via Humapen® Luxura device)
3ml prefilled disposable pen (Kwikpen®)
 
   
Hypurin® Bovine Isophane (Isophane Insulin)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 3ml cartridges (via Autopen® Classic)

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal insulin
 
   
Hypurin® Porcine Isophane (Isophane Insulin)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 3ml cartridge (via Autopen® Classic)

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal insulin
 
   
Hypurin®Bovine Lente (Insulin Zinc suspension)
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Formulary 10ml vial

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal insulin
 
   
06.01.01.02  Long-acting Insulin Analogues
Abasaglar® (Insulin glargine)
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First Choice
Green
3mL pre-filled disposible pen (KwikPen®)
3mL cartridge

**First line insulin glargine in NEW PATIENTS** 
Lantus® (Insulin Glargine)
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Formulary 3ml cartridge (via ClikSTAR® or Autopen®24 devices)
3ml prefilled disposable pen (Solostar®)

 
   
Toujeo® (Insulin Glargine 300units/mL)
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Formulary

1.5ml prefilled disposable pen (Solostar®)

**HIGH-STRENGTH INSULIN PRODUCT** See guidance below

Restricted Item Only to be used in line with GMMMMG recommendations

 
Link  Educational risk-minimisation materials
Link  GMMMG Recommendation: Insulin Glargine – Toujeo® (300 units/mL)
Link  PAT Policy for the Management of High Strength Insulin in the Hospital Setting
   
Levemir® (Insulin Detemir)
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Formulary 3ml cartridges (via Novopen®4 device)
3ml prefilled disposable pen (Flexpen® or Innolet®
   
Tresiba® (Insulin degludec)
(100units/mL)
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Formulary 3ml cartridges (via Novo Nordisk® devices)
3ml pre-filled disposable pen (Flextouch®)

**Only the 100units/mL strength has been approved by the Division of Medicine. Use of the 200units/ml strength requires named-patient approval from Medical D&T Committee Chair** 
   
06.01.02  Antidiabetic drugs to top
06.01.02.01  Sulphonyureas
Gliclazide
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First Choice Tablets
 
Glimepiride
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Formulary Tablets 
   
Glipizide
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Formulary Tablets 
   
06.01.02.02  Biguanides
Metformin
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets
Oral Solution


Green Traffic Light Green3 when used in pregnancy or PCOS 

Metformin Hydrochloride (Modified Release)
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Formulary MR Tablets

Metformin MR should only be used where the standard metformin tablets have been tried and are not tolerated due to GI problems. Any new prescription of the MR preparation should be reviewed soon after initiation (recommend checking HbA1c after 3 months and assess patient for adherence to treatment/adverse effects), discontinue if not tolerated or ineffective. 
   
06.01.02.03  Other antidiabetic drugs
06.01.02.03  Thiazolidinediones (Glitazones)
Pioglitazone (Actos®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
Link  MHRA Pioglitazone and bladder cancer Aug 2011
Link  MHRA Pioglitazone Cardiovascular Safety Jan 2011
   
06.01.02.03  Dipeptidylpeptidase-4 inhibitors (Gliptins) to top
 note 

Dipeptidylpeptidase-4 inhibitors (Gliptins)

Acute pancreatitis associated with gliptins has been reported. Inform patients of the symptoms of acute pancreatitis. If pancreatitis is suspected, the DPP-4 inhibitor should be discontinued.

• Only continue DPP-4 inhibitor therapy if the person has had a beneficial metabolic response (a reduction of at least 0.5 percentage points in HbA1c in 6 months) –as per NICE CG87.

• Monotherapy: Saxagliptin, Sitagliptin and Linagliptin – only if metformin contra-indicated or not tolerated. Alogliptin is not licensed for monotherapy.
• See individual SPCs for details of dosage in renal impairment.

GMMMG IPNTS: DPP-4 inhibitors (‘The Gliptins’) for the treatment of type 2 diabetes mellitus. Feb 2014

Alogliptin (Vipidia®)
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First Choice
Green 1
Tablets

 
Linagliptin (Trajenta®)
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Formulary
Green 1
Tablets

note First choice 'Gliptin' for patients with moderate or severe renal impairment (CrCl<50ml/min, eGFR<59ml/min)
 
   
Saxagliptin (Onglyza®)
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Formulary
Green 1
Tablets

note For established patients only. Alogliptin is first line.
 
   
Sitagliptin (Januvia®)
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Formulary
Green 1
Tablets

note For established patients only. Alogliptin is first line.

 
   
06.01.02.03  GLP-1 receptor mimetics
 note 

GLP-1 mimetics should only be considered as third-line therapy in accordance with NICE CG87/TA203/TA248).

GLP-1 mimetics should only be continued if reduction of at least 1% point in HbA1c AND a weight loss of at least 3% of initial body weight at 6 months

Exenatide (Byetta®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green 1
Disposable pen 
Liraglutide (Victoza®)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green 1
Disposable pen 
Lixisenatide (Lyxumia®)
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Formulary
Green 1
Disposable pen 
Link  NICE ESNM26 Type 2 diabetes: lixisenatide May 2013
   
Exenatide Prolonged Release (Bydureon®)
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Formulary
Green 1
Vial

Once weekly preparation 
Link  NICE TA248: Exenatide Prolonged Release
   
06.01.02.03  SGLT-2 inhibitors
 note 

In individuals with type 2 diabetes and established cardiovascular disease, SGLT-2 inhibitors with proven cardiovascular benefit (currently empagliflozin and canagliflozin) should be considered

Empagliflozin (Jardiance®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
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
   
Dapagliflozin (Forxiga®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary

Tablets

 
Link  GMMMG NTS: SGLT2 Inhibitors for the treatment of adults with type 2 diabetes mellitus to improve glycaemic control.
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
   
Canagliflozin (Invokana®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
Link  GMMMG NTS: SGLT2 Inhibitors for the treatment of adults with type 2 diabetes mellitus to improve glycaemic control.
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
   
06.01.02.03  Other antidiabetic agents
 note 

Nateglinide only licensed for use in combination with metformin. Cautioned in moderate hepatic impairment.

Repaglinide can be given as monotherapy or in combination with metformin. It should be avoided in patients >75 years old and in patients with severe liver disease.

Repaglinide (Prandin®)
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First Choice Tablets 
Nateglinide (Starlix®)
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Formulary Tablets 
   
Acarbose (Glucobay®)
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Formulary Tablets 
   
06.01.02.03  Other
06.01.02.05  Glucagon-like peptide-1 receptor agonists - once weekly to top
06.01.02.07  Other antidiabetic drugs
06.01.03  Diabetic ketoacidosis
06.01.04  Treatment of hypoglycaemia
GlucoGel®
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Formulary  
   
Glucagon (GlucaGen® HypoKit)
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Formulary  
   
06.01.04  Chronic hypoglycaemia
06.01.05  Treatment of diabetic nephropathy and neuropathy to top
Amitriptyline
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First Choice Tablets
Oral solution

unlicensedunlicensed 
Duloxetine (Cymbalta®)
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First Choice Capsules

 
Gabapentin
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Formulary Capsules
Oral solution 
Link  MHRA Safety Update: Risk of severe respiratory depression
   
Pregabalin
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Formulary Capsules

note A trial of pregabalin may be considered in patients who cannot tolerate gabapentin, or who have not responded fully despite an adequate trial. 
   
Nortriptyline
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Formulary Tablets

unlicensedunlicensed

note Useful if the patient gains benefit from amitriptyline but experiences side/adverse effects 
   
Capsaicin
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Formulary Cream 0.075& 
   
06.01.06  Diagnostic and monitoring agents for diabetes mellitus
06.01.06  Oral glucose tolerance test
Oral glucose tolerance test.
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary  
Link  PAT: Adult Endocrine Test Protocols
   
Polycal®
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Formulary  
   
06.02  Thyroid and Antithyroid drugs
06.02.01  Thyroid hormones
Levothyroxine
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First Choice Tablets
Oral liquid 
Liothyronine
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Restricted Drug Restricted
Grey

Tablets
DotFor patients who, in exceptional circumstances, have an on-going need for liothyronine as confirmed by a consultant endocrinologist

DotFor patients with thyroid cancer prior to radioiodine treatment

Injection

DotFor acutely unwell patients with profound hypothyroidism

 
   
06.02.02  Antithyroid drugs to top
Carbimazole
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets

 
Propylthiouracil
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Formulary
Green
Tablets
Prescribing to remain with specialist care until stable.  
Link  FDA Propylthiouracil induced liver failure April 2010
   
Aqueous Iodine Oral Solution (Lugol's)
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Formulary Oral solution 
   
06.03  Corticosteroids
06.03.01  Replacement therapy
Fludrocortisone Acetate (Florinef®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
Link  NICE Evidence Summary: Postural Hypotension in Adults
   
06.03.02  Glucocorticoid therapy
Prednisolone
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First Choice Tablets (NOT enteric coated)
Restricted Item Soluble tablets - paediatrics only

 
Dexamethasone
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First Choice Tablets
Injection
Oral solution 
Hydrocortisone
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First Choice Tablets
Injection (as sodium phosphate)
Injection (as sodium succinate)

 
Betamethasone
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Formulary Injection
Soluble tablets 
   
Methylprednisolone
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Formulary Injection
Depot injection
Tablets 
Link  NICE CG186: Multiple Sclerosis; management in primary and secondary care.
   
Triamcinolone (Kenalog®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
06.04  Sex hormones
06.04.01  Female sex hormones and their modulators to top
06.04.01.01  Oestrogens and HRT
Prempak-C®
(Sequential combined therapy - for women with a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets

Conjugated oestrogens 625micrograms + norgestrel 150micrograms
Conjugated oestrogens 1.25mg + norgestrel 150micrograms

 
Premique® low dose
(Continuous combined therapy - for women with a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets

Conjugated oestrogen 300micrograms + medroxyprogesterone acetate 1.5mg

 
Premique®
(Continuous combined therapy - for women with a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets

Conjugated oestrogen 625micrograms + medroxyprogesterone acetate 5mg

 
Premarin®
(Unopposed oestrogen - for women without a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice Tablets

Conjugated oestrogen 300micrograms
Conjugated oestrogen 625micrograms
Conjugated oestrogen 1.25mg

 
Elleste Duet®
(Sequential combined therapy - for women with a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

Estradiol 1mg + norethisterone 1mg
Estradiol 2mg + norethisterone 1mg


 
   
Evorel Sequi®
(Sequential combined therapy - for women with a uterus)
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Formulary Patches

Estradiol 50micrograms
plus
Estradiol 50micrograms + norethisterone acetate 170micrograms 
   
Femoston®
(Sequential combined therapy - for women with a uterus)
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Formulary Tablets

Estradiol 1mg + dydrogesterone 10mg
Estradiol 2mg + dydrogesterone 10mg


 
   
Femoston Conti®
(Continuous combined therapy - for women with a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

Estradiol 1mg + dydrogesterone 5mg


 
   
Kliovance®
(Continuous combined therapy - for women with a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

Estradiol 1mg + norethisterone acetate 500micrograms 
   
Kliofem®
(Continuous combined therapy - for women with a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

Estradiol 2mg + norethisterone acetate 1mg 
   
Evorel Conti®
(Continuous combined therapy - for women with a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Patches

Estradiol 50micrograms/24hours + norethisterone 170micrograms/24hours
 
   
Elleste-Solo®
(Unopposed oestrogen - for women without a uterus)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

Estradiol 1mg
Estradiol 2mg

 
   
Evorel®
(Unopposed oestrogen - for women without a uterus)
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Formulary Patches

Estradiol 25, 50, 75, 100micrograms 
   
Tibolone (Livial®)
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Formulary Tablets 
   
06.04.01.01  Ethinylestradiol
06.04.01.01  Raloxifene
Raloxifene Hydrochloride (Evista®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
Link  NICE TA161:Osteoporosis - secondary prevention
   
06.04.01.02  Progestogens
Medroxyprogesterone Acetate
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Formulary Tablets 
   
Norethisterone
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Formulary Tablets 
   
Progesterone (Cyclogest®)
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Formulary
Red
Pessaries/suppositories

"Red" when used for infertility 
   
Progesterone (Gestone®)
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Formulary Injection 
   
Ulipristal (Esmya®)
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Formulary
Green 3
Tablets 
Link  GMMMG IPNTS: Ulipristal acetate (Esmya) for the treatment of moderate to severe symptoms of uterine fibroids prior to surgery
   
06.04.02  Male sex hormones and antagonists to top
Testosterone undecanoate
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Formulary
Green 2
IM injection 
   
Testosterone enantate
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Formulary
Green 2
IM injection 
   
Testosterone implant
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Formulary
Green 2
Implant 
   
Testosterone gel  (Testogel®)
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Formulary
Green 2
Gel 
   
Testosterone gel  (Tostran®)
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Formulary
Green 2
Gel 
   
Testosterone oral (Restandol Testocaps®)
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Formulary
Green 2
Capsules 
   
06.04.02  Anti-androgens
Finasteride
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First Choice Tablets 
Cyproterone Acetate
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Formulary
Green 2
Tablets 
   
Dutasteride (Avodart®)
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Formulary Tablets 
   
06.04.03  Anabolic steroids
06.05  Hypothalamic and pituitary hormones and anti-oestrogens
06.05.01  Hypothalamic and anterior pituitary hormones and anti-oestrogens
06.05.01  Anti-oestrogens to top
Clomifene Citrate
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Formulary
Red
Tablets

Restricted Item Only indicated for patients in whom ovulatory dysfunction has been demonstrated and other causes of infertility have been excluded or adequately treated 
   
06.05.01  Anterior pituitary hormones
Chorionic Gonadotrophin (Pregnyl®)
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Formulary
Red
Injection 
   
Human Menopausal Gonadotrophins (Menopur®)
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Formulary
Red
Injection 
   
Tetracosactide (Synacthen®)
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Formulary
Red
250 microgram/ml injection (for short 30-minute test)
1mg/ml depot injection (for 5-hour test) 
Link  PAT Adult Endocrine Test Protocols (includes ’Synacthen test’)
   
06.05.01  Hypothalmic hormones
06.05.02  Posterior pituitary hormones and antagonists
06.05.02  Posterior pituitary hormones
Desmopressin
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Formulary Tablets
Sublingual tablets
Nasal Spray
Injection 
Link  MHRA: Desmopressin nasal spray: Removal of the primary nocturnal enuresis (bedwetting ) indication
   
Terlipressin (Glypressin®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
Vasopressin (Pitressin®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
06.05.02  Antidiuretic hormone antagonists to top
Demeclocycline
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules

note See section 6.5.2 of BNF for details of dosage in SIADH unlicensedunlicensed 
   
Tolvaptan (Samsca®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
High Cost Medicine
Tablets


 
Link  GMMMG Guidance: Tolvaptan for hyponatraemia caused by SIADH
Link  MHRA Drug Safety Update: Tolvaptan - risk of liver injury
   
06.06  Drugs affecting bone metabolism
06.06  Osteoporosis
06.06.01  Calcitonin and parathyroid hormone
Calcitonin (salmon) / Salcatonin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Injection 
   
Teriparatide (Forsteo®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
High Cost Medicine
Injection

Restricted Item 2nd line treatment for severe osteoporosis in accordance with NICE guidance. For specialist use only

PbR excluded - commissioned by CCG  
Link  NICE TA161: Osteoporosis - secondary prevention
   
06.06.02  Bisphosphonates and other drugs affecting bone metabolism
 note  MHRA Drug Safety Alert: minimising the risk of osteonecrosis of the jaw with denosumab and intravenous bisphosphonates
06.06.02  Bisphosphonates to top
Alendronic Acid
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice 70mg tablets (once weekly preparation)

 
Risedronate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary 35mg tablets (once weekly preparation) 
   
Sodium Clodronate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets

Restricted Item Specialist Initiation Only 
   
Disodium Pamidronate
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Concentrate for Intravenous Infusion

note Refer to Electrolyte Disturbances Guidelines for dosage in hypercalcaemia 
Link  PAT: Electrolyte Disturbances Guidance
   
Ibandronic Acid (Bondronat®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
50mg Tablets
Concentrate for infusion

note Approved for reduction of bone damage in bone metastases in advanced breast cancer

 
   
Zoledronic Acid (Aclasta®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Intravenous infusion

note For:
Paget's disease of bone,
Postmenopausal osteoporosis (Restricted ItemSee GMMMG NTS recommendation),
and osteoporosis in men 
Link  GMMMG NTS: Aclasta for postmenopausal osteoporosis
Link  Patient alert card: osteonecrosis of the jaw
   
Zoledronic Acid (Zometa®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Intravenous infusion

note For reduction of bone damage in advanced malignancies involving bone, and hypercalcaemia of malignancy 
Link  Patient alert card: osteonecrosis of the jaw
   
06.06.02  Denosumab
 note   
Denosumab (Prolia®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Injection

 
Link  MHRA Safety Update: minimising the risk of osteonecrosis of the jaw
Link  Patient alert card: osteonecrosis of the jaw
Link  MHRA Safety Update: risk of severe hypocalcaemia
Link  NICE TA204: Osteoporotic fractures - denosumab
Link  GMMMG NTG: Use in Prostate Cancer (NOT recommended)
   
Denosumab (XGEVA®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Injection 
Link  MHRA Safety Update: minimising the risk of osteonecrosis of the jaw
Link  Patient alert card: osteonecrosis of the jaw
Link  MHRA Safety Update: risk of severe hypocalcaemia
Link  NICE TA265: Bone metastases from solid tumours - denosumab: guidance (TA265 )
   
06.06.02  Strontium renelate
Strontium Ranelate (Protelos®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Granules

Restricted Item Specialist Initiation Only 
Link  MHRA Drug Safety Update - Strontium (cardiovascular risk) 2014
Link  NICE TA161: Osteoporosis - secondary prevention
   
06.07  Other endocrine drugs
06.07.01  Bromocriptine and other dopaminergic drugs
Bromocriptine
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets
Capsules

 
   
Cabergoline
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Tablets 
   
06.07.02  Drugs affecting gonadotrophins to top
Danazol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary Capsules 
   
06.07.02  Gonadorelin analogues
Goserelin
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Intradermal implant 3.6mg (every 28 days)

note  For use in breast and prostate cancer, see sections 8.3.4.1 and 8.3.4.2.

"Amber" for licensed indications, "Red" for all unlicensed uses.  
   
Leuprorelin (Prostap®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Amber
Prefilled dual chamber syringe
3.75mg (monthly)
11.25mg (every 3 months)

note For use in prostate cancer, see section 8.3.4.2.

"Amber" for licensed indications, "Red" for all unlicensed uses.  
   
06.07.02  Breast pain (mastalgia)
06.07.03  Metyrapone
Metyrapone (Metopirone®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Capsules

Restricted Item For specialist use only 
   
06.07.04  Somatomedins
 ....
 Non Formulary Items
Alendronic Acid

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary 10mg once daily tablets
 
Alendronic Acid with colecalciferol  (Fosavance®)

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Bedol®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Biphasic Isophane Insulin  (Mixtard® 30)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary DISCONTINUED
 
Buserelin

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Red
 
Cetrorelix  (Cetrotide®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Red
 
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
 
Climagest®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Climaval®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Climesse®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Clinorette®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Corifollitropin Alfa  (Elonva®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cyclo-Progynova®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Deflazacort  (Calcort®)

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
 
Disodium Etidronate  (Didronel PMO®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Disodium Etidronate  (Didronel®)

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
 
Elleste-Duet Conti®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Elleste-Solo®MX

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Estraderm MX®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Estradot®

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Femseven®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
FemSeven® Conti

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
FemSeven® Sequi

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

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Red
 
Ganirelix  (Orgalutran®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Gestrinone  (Dimetriose®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Gliclazide Modified Release

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

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

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary DISCONTINUED
 
Hydrocortisone MR  (Plenadren)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ibandronic acid  (Bonviva®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary 150mg tablets (once a month preparation)

 
Indivina®

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

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 500 units in 1mL  (Humulin R®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary unlicensedunlicensed
 
Insulin degludec  (Tresiba®)
(200units/mL)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary **Only the 100units/mL strength has been approved by the Division of Medicine. Use of the 200units/ml strength requires named-patient approval from Medical D&T Committee Chair**
 
Insulin degludec with insulin aspart  (DegludecPlus)

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
 
Linagliptin/ metformin  (Jentadueto®)

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
 
Mecasermin  (Increlex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mesterolone  (Pro-Viron®)

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

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 Hydrochloride  (Glucophage®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Nandrolone  (Deca-Durabolin®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Novofem®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Nuvelle®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Oestrogel®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Parathyroid Hormone  (Preotact®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Pegvisomant  (Somavert®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Amber
 
Pioglitazone and Metfomin  (Competact®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Prednisone MR

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Progynova®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Progynova® TS

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

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary DISCONTINUED
 
Quinagolide  (Norprolac®)

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

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary DISCONTINUED
 
Sandrena®

View adult BNF View SPC online View childrens BNF Track Changes
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
 
Sodium Clodronate  (Clasteon®)

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Amber
Link  NICE TA188: Human growth hormone (somatropin) for the treatment of growth failure in children (review)
Link  NICE TA64: Growth hormone deficiency (adults) - human growth hormone
 
Somatropin  (Saizen®)

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Amber
 
Testosterone and Esters  (Andropatch®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Testosterone and Esters  (Intrinsa®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Testosterone and Esters  (Striant® SR)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Testosterone propionate  (Virormone®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tiludronic Acid  (Skelid®)

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
 
Tridestra®

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
 
Trilostane  (Modrenal®)

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

View adult BNF View SPC online View childrens BNF Track Changes
Non Formulary
Amber
 
Trisequens®

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

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

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

View adult BNF View SPC online View childrens BNF Track Changes
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
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

netFormulary