netFormulary NHS
North East and North Cumbria
ICS Formulary
 Search
 Formulary Chapter 6: Endocrine system - Full Chapter
Chapter Links...
 Details...
06.04  Expand sub section  Sex hormones
06.04.01  Expand sub section  Female sex hormones and their modulators
06.04.01.01  Expand sub section  Oestrogens and Hormone Replacement Therapy HRT
Oestrogen conjugated tablets 625microgram and 1.2mg (Premarin®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Estradiol patches/gel/spray
(Oestrogen only patches/gel)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Twice weekly matrix patches releasing approximately 25, 37.5 (Estradot® only), 50, 75 & 100 microgram/24 hours (Estradot®,Evorel®, Estraderm® MX);
  • Weekly matrix patches releasing approximately 25, 50, 75 & 100 microgram/24 hours (Femseven®);
  • Once weekly matrix patches releasing approx. 50 & 100 microgram estradiol/24 hours (Progynova TS®)
  • Estradiol 0.1% gel (Sandrena®)
  • Estradiol 0.06% gel (Oestrogel®) 
    • Approved for use in gender dysphoria therapy Green plus
    • Approved for use as hormone replacement therapy
  • Estradiol 1.53mg/spray transdermal spray (Lenzetto®)
    • Approved as an alternative to patches and gels for patients who have issues with absorption, find patch adhesive irritating or the gel messy

 

 
 
Estradiol tablets
(Oestrogen only tablets)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 1mg and 2mg tablets
 
 
Ethinylestradiol
(Oestrogen only tablets)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Note: ethinylestradiol 2microgram tablets are unlicensedunlicensed.
 
 
Continuous combined HRT patch (Evorel® Conti)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Combined cyclical HRT tablet (Elleste Duet®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Pack of 16 x 1mg estradiol tablets + 12 x 1mg estradiol and 1mg norethisterone tablets
 
 
Combined cyclical HRT tablet (Femoston®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Femoston® 1/10 Tablets:
    • Pack of 14 x 1mg estradiol tablets + 14 tablets containing estradiol 1mg and dydrogesterone 10mg

 

  • Femoston® 2/10 Tablets:
    • Pack of 14 x 2mg estradiol tablets + 14 tablets containing estradiol 2mg and dydrogesterone 10mg
 
 
Continuous combined HRT tablets (Elleste-duet Conti, Kliofem, Kliovance, Femosten Conti, Premique-low dose)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Estradiol vaginal tablet
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 10mg vaginal tablet
    • Vagifem®
    • Vagirux® (alternative)


 
 
Sequential combined cyclical HRT patch (Evorel® Sequi)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Tibolone
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
06.04.01.01  Expand sub section  Hormone replacement therapy
06.04.01.01  Expand sub section  Ethinylestradiol to top
06.04.01.01  Expand sub section  Raloxifene
Raloxifene Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • For use on the advice of specialists in the prevention and treatment of osteoporosis where alternative treatments are inappropriate.
 
Link  NICE TA160: Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women (Not Approved)
Link  NICE TA161: Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
 
06.04.01.01  Expand sub section  Oestrogen only tablets
06.04.01.01  Expand sub section  Oestrogens and progestogen sequential combined therapy
06.04.01.01  Expand sub section  Continuous combined therapy
06.04.01.01  Expand sub section  Gonadomimetic to top
06.04.01.01  Expand sub section  Selective oestrogen modulator
06.04.01.02  Expand sub section  Progestogens
Norethisterone 5mg tablets
View adult BNF View SPC online View childrens BNF
First Choice
Green
 
Levonorgestrel (Mirena®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • Levonorgestrel 52mg in a T-shaped intra-uterine system. 
  • For idiopathic menorrhagia. Especially in women requiring (reversible) contraception. Also used for protection with endometrial hyperplasia during oestrogen replacement therapy. Lasts for up to 5 years - for use in accordance with agreed guidelines.
 
 
Medroxyprogesterone Acetate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Approved Medroxyprogesterone formulations include:

  • 2.5mg, 5mg, and 10mg tablets (sometimes used as a progestogen component of HRT).
  • 100mg & 200mg tablets (for use in malignant disease see section 8.3.2).
  • 50mg in ml injection - see sections 7.3.2.2 for use of  medroxyprogesterone acetate injection in contraception.
 
 
Micronised progesterone (Utrogestan®)
View adult BNF View SPC online View childrens BNF
Formulary
  • 100mg oral capsules Green
  • Approved for:
    • adjunctive use with estrogen in post-menopausal women with an intact uterus, as hormone replacement therapy (HRT)
    • Perimenopause (off-label)
    • Premature ovarian insufficiency (off-label)
    • Adolescents undergoing pubertal induction following chemotherapy (off-label)


 
 
Progesterone
View adult BNF View SPC online View childrens BNF
Formulary
  • Approved formulations include:
    • 200mg & 400mg pessaries (Cyclogest®) Green
    • 25mg SC/IM injection (Lubion®) Red
      • Approved for luteal support in patients who have had a previous failed biochemical pregnancy in a froxen embryo transfer (FET) cycle
  • CD&TV Red for Luteal Phase support following IVF.
    • Full course to be supplied by hospital
  • CD&TV  Green plus to support the pregnancies of women who have a history of miscarriage or premature labour as per NICE NG25: Preterm labour and birth.
 
 
Ulipristal (Esmya®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red
  • 5mg tablets

    • Approved for the pre-operative treatment of uterine fibroids for one 3 month course, as per its product licence.
    • Approved for the medical treatment of uterine fibroids in women unsuitable for surgery, up to a maximum of four 3 month intermittent courses, as per its product licence and reviewed regularly.
    • Contraindicated in women with underlying liver disorders.  
    • Requirements for liver function monitoring before, during, and after treatment
 
Link  MHRA Drug Safety Update (Feb 2021): Ulipristal acetate 5mg (Esmya): further restrictions due to risk of serious liver injury
 
06.04.02  Expand sub section  Male sex hormones and antagonists
Testosterone undecanoate 1gram in 4ml oily injection (Nebido®)
View adult BNF View SPC online View childrens BNF
First Choice
Green plus
  • Injection: 1g in 4 mL (250 mg/mlL oily injection)
 
Testosterone Enantate
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 250mg/ml solution for injection ampoules
 
 
Testosterone (1.62%)  (Testogel®)
View adult BNF View SPC online View childrens BNF
Alternatives
  • Gel pump dispenser 16.2mg/g (60 x 1.25g metered doses)  
    • Approved for hypogonadism on the advice of an endocrinologist Green plus
  • 2.5g sachets (40.5mg/2.5g)
    • Approved for hypogonadism on the advice of an endocrinologist Green plus 
    • Management of low libido in menopausal (both natural and surgical) and post-menopausal women (unlicensed indication) in accordance with attached guidance Green

       

 
Link  NENC ICB - Management of the Menopause
Link  NICE NG23: Menopause: diagnosis and management
 
Testosterone gel pump (Tostran®)
View adult BNF View SPC online View childrens BNF
Alternatives
  • 10mg in 0.5ml (2%)/metered dose
    • Approved for hypogonadism on the advice of an endocrinologist Green plus 
    • Management of low libido in menopausal (both natural and surgical) and post-menopausal women (unlicensed indication) in accordance with attached guidance Green
 
Link  NENC ICB - Management of the Menopause
 
Testosterone transdermal gel (Testavan®)
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • 20mg/g transdermal gel
    • Approved for hypogonadism on the advice of an endocrinologist 
 
 
Testosterone 1ml injection (Sustanon 250®)
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Sustanon® 250 1ml injection contains testosterone propionate 30mg, testosterone phenylpropionate 60mg, testosterone isocaproate 60mg and testosterone decanoate 100mg.
 
 
06.04.02  Expand sub section  Anti-androgens
Dutasteride
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • 500mcg capsules
 
 
Finasteride 5mg tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  NICE CG97 Lower urinary tract symptoms: quick reference guide
 
Cyproterone Acetate 50mg and 100mg tablets
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • Approved for use on the advice of a urologist.
 
Link  MHRA Drug Safety Update (June 2020): Cyproterone acetate: new advice to minimise risk of meningioma
 
06.04.03  Expand sub section  Anabolic steroids to top
06.04.04  Expand sub section  Gender dysphoria
Buserelin 150microgram Nasal Spray (Suprecur®)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
  • 150 micrograms per spray; 268 dose spray
 
 
Cyproterone Acetate
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
  • Tablets: 50mg & 100mg
 
Link  MHRA Drug Safety Update (June 2020): Cyproterone acetate: new advice to minimise risk of meningioma
 
Estradiol 1mg and 2mg tablets
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
 
 
Finasteride 5mg tablets
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
 
 
Goserelin 3.6mg injection
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
 
 
Leuprorelin 11.25mg injection
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
 
 
Spironolactone
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
  • Tablets: 25 mg & 100 mg
 
 
Testosterone 1ml injection (Sustanon® 250)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
  • Sustanon® 250 1ml injection contains testosterone propionate 30mg, testosterone phenylpropionate 60mg, testosterone isocaproate 60mg and testosterone decanoate 100mg.
 
 
Testosterone Gel
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus
  • 23 mg/1.15 g (23 mg per actuation); 85.5 g (Testavan®)
  • 50 mg/5 g (50 mg per tube); 30 tubes (Testim®)
  • 16.2 mg/g (20.25 mg per actuation); 88 g (Testogel®)
  • 50 mg/5 g sachet; 30 sachets (Testogel®)
  • 20 mg/g (10 mg per actuation); 60 g (Tostran®)
 
 
Testosterone undecanoate 1gram in 4ml oily injection (Nebido®)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus

1g in 4 mL (250 mg/ml oily injection)

 
 
Triptorelin Injection
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green plus

3 mg, 3.75 mg, 11.25 mg and 22.5 mg

 
 
 ....
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
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

netFormulary