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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
06.01.01.01  Short-acting insulins
 note 

Note: preloaded pens and Innolet® devices should only be used where cartridges are not suitable.

Insulin (Actrapid® )
(Rapidly acting)
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Formulary
Green
  • Human Actrapid® 10ml vial approved. 
 
 
Insulin (Humulin® S)
(Rapidly acting)
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Formulary
Green
  • Approved formulations of Humulin® S include:
    • 10ml vials;
    • 5x3ml cartridges.

 
 
Insulin (Insuman® Rapid)
(Rapidly acting)
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Formulary
Green
  • Insuman® Rapid 5x3ml cartridges.
 
 
Insulin Aspart (Fiasp®)
(Ultra-fast, short acting)
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Formulary
Green

  • Approved formulations for Fiasp® include:


    • 10ml vial;

    • 5x3ml cartridge;

    • 5x3ml FlexpTouch pen®.



 
 
Insulin Aspart  (NovoRapid® Trurapi®)
(Very rapidly acting )
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Formulary
Green
  • Approved formulations for Novorapid® include:
    • 10ml vial;
    • 5x3ml cartridge (for use with Novopen and Novopenmate devices);
    • 5x3ml Flexpen®.
  • Approved formulations for Trurapi® include:
    • 100 units/ml 10ml vial
    • 100 units/ml cartridge
    • 100 units/ml pre-filled pen

Trurapi = BLACK TRIANGLE

 
 
Insulin Lispro 100 units/ml (Humalog®)
(Very rapidly acting)
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Formulary
Green
  • Approved formulations for Humalog 100 ® include:
    • 10ml vial;
    • 5x3ml cartridge;
    • 5x3ml Kwiikpen®.
  • Prescriptions need to be written as Insulin Lispro Sanofi® or Humalog® to avoid prescribing/dispensing errors.
  • Note that there are two strengths of Humalog® (insulin lispro). Caution should be exercised when prescribing and dispensing
 
 
Insulin Lispro 200 units/ml (Humalog®)
(Very rapidly acting)
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Formulary
Green
  • 200 units per ml
  • Approved formulations for Humalog 200® include the 5x3ml Kwikpen®.
  • Note that there are two strengths of Humalog® (insulin lispro). Caution should be exercised when prescribing and dispensing
 
 
Insulin Lispro SanofiBlack Triangle
(Very rapidly acting)
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Formulary
Green
  • 100units /ml
  • 10ml vial 3ml cartridges (for AllStar Pro and JuniorSTAR pen), 3ml SoloStar prefilled pen
  • Prescriptions need to be written as Insulin Lispro Sanofi® or Humalog® to avoid prescribing/dispensing errors. Insulin lispro biosimilar
 
 
Insulin Glulisine (Apidra®)
(Very rapidly acting)
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Formulary
Green
  • Approved Apidra® formulations include:
    • 10ml vials;
    • 5x3ml cartridges
    • 5x3ml Solostar® pens.

 
 
Insulin Human 500 units in 1mL (Humulin R®)
(Rapidly acting)
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Unlicensed Drug Unlicensed
Red

  • Humulin R 500units in 1ml (10ml vial) approved for a very small number of insulin resistant patients that require very high doses of insulin. 

 
 
06.01.01.01  Short-acting human insulin analogues
06.01.01.02  Intermediate- and long-acting insulins to top
 note 

Note: preloaded pens and Innolet® devices should only be used where cartridges are not suitable.

Isophane Insulin (Insulatard®)
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Formulary
Green
  • Approved Insulatard® formulations include:
    • 10ml vial;
    • 5x3ml cartridges (for use with Novopen® and Novopenmate® devices);
    • 5x3ml Innolet® pens. 

 
 
Isophane Insulin (Humulin® I)
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Formulary
Green
  • Approved Humulin® I formulations include:
    • 10ml vials;
    • 5x3ml cartridges;
    • 5x3ml pens. 

 
 
Isophane Insulin (Insuman® Basal)
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Formulary
Green
  • Insuman® Basal formulations 5x3ml Solostar® pens. 

 

 

 
 
Insulin Glargine biosimilar Abasaglar®
(Long acting)
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Formulary
Green
  • First choice long acting basal insulin in patients eligible for treatment in line with NICE and NTAG
  • Approved Abasaglar® formulations include:
    • 5x3ml cartridge
    • 5x3ml Kwikpen®.

 
Link  NG17: Type 1 diabetes in adults: diagnosis and management
Link  NTAG: Abasaglar® Insulin Glargine Biosimilar 100 units/ml for the treatment of type 1 or type 2 diabetes mellitus.
 
Insulin degludec  (Tresiba®)
(Long acting)
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Formulary
Green plus

  • 100 units/mL only

  • Pre-filled pen and cartridges

  • Approved for use in patients with Type 1 diabetes with


    • Nocturnal/Severe Hypogycaemia (with or without hypoglycaemic unawareness) in patients who would otherwsie progress to insuling pump treatment as per NICE TA151); or

    • Recurrent DKA episodes despite good compliance and who would otherwise progress to insulin pump therapy

    • Paediatric patients who cannot tolerate glargine sting

    • Paediatric patients with poor control on the high HbA1c pathway

    • Patients or Parents/Carers with unpredictable lifestyles such as students or shift workers.



 
 
Insulin Detemir (Levemir®)
(Long acting)
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Formulary
Green
  • Alternative choice long acting basal insulin.
  • Approved Levemir® formualtions include:
    • 5x3ml cartridges;
    • 5x3ml pens. 

 
 
Insulin Glargine (Lantus®)
(Long acting)
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Formulary
Green
  • Alternative choice long acting basal insulin. 
  • Approved Lantus® formulations include:
    • 10ml vials;
    • 5x3ml cartridges;
    • 5x3ml pens (Solostar® - in line with NICE). 
 
 
Insulin Glargine  (Toujeo®)
(Long acting)
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Formulary
Green
  • Alternative choice long acting basal insulin.
  • Approved Toujeo® formulations include:
    • 3x1.5ml pen (Solostar®).

 
 
06.01.01.02  Biphasic insulins
Biphasic Isophane Insulin (Humulin® M3)
(Conventional )
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Formulary
Green
  • Approved Humulin®M3 formulations include:
    • 10ml vials;
    • 5x3ml cartridges;
    • 5x3ml pens. 

 
 
Biphasic Isophane Insulin (Insuman® Comb 25)
(Conventional)
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Formulary
Green
  • Insuman Comb 25%/75% 100 units/ml SoloStar pre-filled pen
 
 
Biphasic Insulin Aspart (NovoMix® 30)
(Analogue)
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Formulary
Green
  • Approved NovoMix® 30 formulations include:
    • 5x3ml cartridges (for use with Novopen® and Novopen® Penmate injection devices)
    • 5x3ml Flexpen® pens. 

 
 
Biphasic Insulin Lispro (Humalog® Mix 25 amd Mix 50)
(Analogue)
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Formulary
Green
  • Approved formulations of Humalog® Mix 25 and Mix 50 include:
    • 5x3ml cartridges
    • 5x3ml Kwikpen®
 
 
06.01.01.03  Hypodermic equipment
06.01.01.03  Needles
06.01.01.03  Lancets
06.01.02  Antidiabetic drugs to top
06.01.02.01  Sulphonyureas
Gliclazide
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First Choice
Green
  • 40mg & 80mg tablets

  • 30mg MR tablets
    • *Not to be prescribed for new patients*
    • Exisiting patients can continue until clinically appropriate to change in line with switch policy
 
Glimepiride
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Formulary
Green
 
 
Glipizide
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Formulary
Green
 
 
Tolbutamide
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Formulary
Green
 
 
06.01.02.02  Biguanides
Metformin
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Formulary
Green
  • Metformin 500mg tablets
  • Metformin 500mg oral powder sachets
  • Metformin MR (once daily - Glucophage® SR) are only approved for use in patients who have failed to tolerate the conventional tablets despite careful dose titration.
  • Note: metformin is also approved for use in Polycystic Ovary Syndrome.

 

 
Link  MHRA Drug Safety Update (June 2022): Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk
Link  MHRA Drug Safety Update (Mar 2022): Metformin in pregnancy: study shows no safety concerns
 
06.01.02.03  Other antidiabetic drugs
Repaglinide
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Formulary
Green
 
 
06.01.02.03  Alpha glucosidase inhibitors
Acarbose
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Formulary
Green
 
 
06.01.02.03  DPP4 inhibitors (gliptins) to top
Alogliptin
(DPP4 inhibitor)
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Formulary
Green
 
 
Linagliptin
(DPP4 inhibitor)
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Formulary
Green
 
 
Saxagliptin (Onglyza®)
(DPP4 inhibitor)
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Formulary
Green
 
 
Sitagliptin
(DPP4 inhibitor)
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Formulary
Green
 
 
06.01.02.03  GLP1 agonists
Dulaglutide (Trulicity®)
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Formulary
Green
  • 0.75mg, 1.5mg, 3mg and 4.5mg prefilled syringes
    • Approved for use in patients who require once-weekly GLP-1 receptor agonist therapy. 
    • This has replaced once-weekly exenatide. Existing patients can continue to receive exenatide until reviewed by a specialist

 

 
Link  National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update
Link  NICE NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management
 
Exenatide
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Formulary
Green
  • 5 microgram and 10 microgram per dose are prefilled injection pens containing a 250microgram/ml solution for subcutaneous injection.
    • Only approved for use in accordance with NICE guidance Treatment must be initiated by a consultant diabetologist and use is limited to overweight patients with type 2 diabetes in line with NICE guidelines.
  • 2.5mg/0.85ml prolonged-release suspension for injection
    • temporarily approved due to supply issues with semaglutide and dulaglutide (please refer to linked advice below)

 

 
Link  EXENATIDE (Byetta®) - Information for Primary Care
Link  National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update
 
Lixisenatide
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Formulary
Green
 
Link  National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update
 
Semaglutide
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Formulary
Green
  • 0.25mg/0.19mL, 0.5mg/0.37mL and 1mg/0.7mL solution for injection pre-filled pen (Ozempic®)
    • Approved for the treatment of type 2 diabetes in patients who require an intensification in treatment
  • 3mg, 7mg & 14mg tablets (Rybelsus®) - BLACK TRIANGLE
    • Approved as an option for patients with type 2 diabetes mellitus who require intensification of treatment, if use of a glucagon-like peptide 1 receptor agonist (GLP1RA) is clinically appropriate, in line with licensing and relevant guidance, and if an oral option is preferred.
  • 0.25mg/0.37ml, 0.5mg/0.37ml, 1mg/0.75ml, 1.7mg/0.75ml & 2.4mg/0.75ml solution for injection pre-filled pens (Wegovy®Red
    • Approved for managing overweight and obesity in line with NICE guidance within a specialist weight management service (including but not limited to tiers 3 and 4)
    • Also available via NHSE pilot sites involving primary care

 

 
Link  National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update
Link  NICE TA875: Semaglutide for managing overweight and obesity
Link  NTAG Treatment Appraisal: Oral semaglutide for the treatment of type 2 diabetes mellitus.
 
Tirzepatide (Mounjaro®)
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Formulary
Green
  • 2.5mg/0.6ml  & 5mg/0.6ml solution for injection (pre-filled pens)
  • Approved for treating type 2 diabetes in line with NICE
 
Link  NICE TA924: Tirzepatide for treating type 2 diabetes
 
Liraglutide
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Formulary
  • Victoza® Green
    • Approved for the treatment of type 2 diabetes mellitus in accordance with NICE guidance   
  •  Saxenda®Red
    • Approved as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults in line with NICE and providing: 
      • it is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service; and
      • the company provides it according to the commercial arrangement 


 
Link  National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update
Link  NICE NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management
Link  NICE NG28: Type 2 diabetes in adults: management
Link  NICE TA664: Liraglutide for managing overweight and obesity
 
06.01.02.03  Meglitinides
06.01.02.03  SGL2 inhibitors
Canagliflozin
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Formulary
Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA315: Canagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
 
Dapagliflozin (Forxiga®)
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Formulary
  • 5mg and 10mg tablets
    • Approved for treating type 2 diabetes in adults Green  
    • Approved for the treatment of chronic kidney disease in adults in line with NICE and NTAG Green

 

 
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
Link  NICE TA775: Dapagliflozin for treating chronic kidney disease
 
Empagliflozin
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Formulary
Green
  • Approved in combination therapy for treating type 2 diabetes in line with NICE 
  • Approved for the treatment of type 2 diabetes in line with NICE 
  • Approved for treating chronic kidney disease in line with NICE
 
Link  NICE NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management
Link  NICE TA336: Empagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
Link  NICE TA942: Empagliflozin for treating chronic kidney disease
 
Ertugliflozin
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Formulary
Green
  • Approved as monotherapy or with metformin for the treatment of type 2 diabetes in line with NICE

 

 
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
 
Sotagliflozin
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Formulary
Green
  • 200mg tablet
    • Approved with insulin for treating type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy in line with NICE

 

 
Link  NICE TA622: Sotagliflozin with insulin for treating type 1 diabetes
 
06.01.02.03  Thiazolidinediones
Pioglitazone
(Thiazolidinedione)
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Formulary
Green
 
 
06.01.03  Diabetic ketoacidosis to top
06.01.04  Treatment of hypoglycaemia
Diazoxide
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Formulary
Green
  • Diazoxide suspensions can be obtained/prepared if needed. unlicensedunlicensed
 
 
Glucagon
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Formulary
  • GlucaGen® Hypokit - 1mg powder and solvent for solution for injection Green

 

 
 
Glucose 5%, 10%, 25% & 50%
(Injection)
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Formulary
Green
 
 
LIFT Juice Shot
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Formulary
  • Carbohydrate drink
  • Approved for the treatment of mild to moderate hypoglycaemia in children and young people 
    • First choice ahead of Glucogel® Green plus
 
 
Glucose 40% Oral Gel (GlucoGel®)
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Formulary
Green
 
 
06.01.04  Chronic hypoglycaemia
06.01.05  Treatment of diabetic nephropathy and neuropathy
06.01.05  Diabetic nephropathy
06.01.05  Diabetic neuropathy to top
Duloxetine 30mg and 60mg capsules
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First Choice
Green
 
Amitriptyline
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Second Choice
Green
 
 
Gabapentin
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Third Choice
Green
  • Also approved for hospital use as an adjunct to other treatment in
    the management of peri/post-operative pain. Red
  • GPs should not be asked to prescribe gabapentin for this unlicensedunlicensed indication.
 
Link  MHRA Drug Safety Alert (Oct 2017): Gabapentin (Neurontin): risk of severe respiratory depression
 
Controlled Drug Pregabalin
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Alternatives
Green
 
Link  MHRA Drug Safety Update (Apr 2022): Pregabalin (Lyrica): findings of safety study on risks during pregnancy
Link  MHRA Drug Safety Update (Feb 2021): Pregabalin (Lyrica): reports of severe respiratory depression
 
Controlled Drug Tramadol
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Alternatives
Green
  • 50mg capsules, 50mg dispersible tablets & 100mg/2ml injection
 
 
06.01.06  Diagnostic and monitoring agents for diabetes mellitus
06.01.06  Blood glucose monitoring
Dexcom One®
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Formulary
Green plus
  • Recommended for use only as per NTAG advice and NHS England Guidance.

 

 
Link  NTAG Continuous Glucose Monitoring (CGM) System Position Statement
 
Freestyle Libre® Flash Blood Glucose Monitoring System
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Formulary
Green plus
  •  Recommended for use only as per NTAG advice and NHS England Guidance.

 

 
Link  NTAG Continuous Glucose Monitoring (CGM) System Position Statement
 
i-Port Advance®
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Formulary
Red
  • Recommended for use only as per NTAG advice and NHS England Guidance.

 

 
Link  NTAG i-Port Advance® Position Statement
 
06.01.06  Urinalysis
06.01.06  Oral glucose tolerance test
06.01.06  Blood glucose meters for adults with type 2 diabetes to top
06.01.06  Blood glucose meters for children and adults with type 1 diabetes
06.01.06  Blood glucose meters for patients on continuous insulin infusion pump
06.01.06  Blood glucose meters for patients with dexterity problems
06.01.06  Talking blood glucose meters
06.02  Thyroid and Antithyroid drugs to top
06.02.01  Thyroid hormones
Levothyroxine
(Thyroxine)
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First Choice
Green
  • 25microgram, 50microgram, 75microgram & 100 microgram tablets
  • 25microgram in 5ml, 50microgram in 5ml & 100microgram in 5ml sugar-free oral solution
 
Liothyronine Injection
(Triiodothyronine)
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Formulary
Red

 

20mcg injection

 

 

 
Link  Items which should not routinely be prescribed in primary care
 
Liothyronine Tablets
(Triiodothyronine)
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Formulary
Green plus

Note: Liothyronine 20mg tablets should only be prescribed as per the following guidance:

  • In line with British Thyroid Association (BTA) guidance, where levothyoroxine has failed, liothyronine may be recommended for individual patients after a carefully audited trial of at least 3 months duration of liothyronine.
  • Existing patients should be reveiwed, as appropriate, by an endocrinologist to ensure the continuing need for liothyronine. Patients shouldn't have treatment stopped without review by an endocrinologist. 

 

 

 
Link  Items which should not routinely be prescribed in primary care
 
06.02.02  Antithyroid drugs
Carbimazole
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First Choice
Green
 
Propylthiouracil
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Alternatives
Green
 
 
Iodine (Lugol's® Iodine)
(Aqueous iodine oral solution)
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Alternatives
Red
  • Oral solution containing 130mg total iodine/ml (5% iodine & 10% potassium iodide).
 
 
Propranolol 80mg MR capsules
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Alternatives
Green
  • Propranolol 80mg MR capsules is the preferred formulation for relief of thyrotoxic symptoms.
 
 
Iopanoic acid
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Unlicensed Drug Unlicensed
Red
  • Approved for use in rapid blockade of thyrotoxicosis in otherwise medically resistant patients prior to surgery/thyroidectomy.
 
 
Potassium Iodate 85mg tablets
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Unlicensed Drug Unlicensed
Red
  • Mainly used by medical physics.
 
 
06.03  Corticosteroids
06.03.01  Replacement therapy
Hydrocortisone 10 mg, and 20mg tablets
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Formulary
Green
  • Hydrocortisone 10mg in 5ml suspension is also approved for use. unlicensed unlicensed
 
 
Hydrocortisone sodium succinate
(Injection)
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Formulary
Green
 
 
Fludrocortisone
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Formulary
Green
 
 
06.03.02  Glucocorticoid therapy to top
Prednisolone
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First Choice
Green
  • The lowest cost formulation should be used when clinically appropriate.  Formulations approved include:
    • 1mg, 5mg tablets;
    • 5mg soluble tablets;
    • 1mg in 1ml oral solution (Prednisolone Dompé®);
    • 5mg suppositories.
 
Hydrocortisone sodium phosphate (Efcortesol®)
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Formulary
Green
  • 100mg/ml solution for injection
  • As an additional option to hydrocortisone sodium succinate for patients who are steroid dependent (pituitary or adrenal cause and occasionally non-endocrine reasons for long term steroid use) to manage sick day rules to avoid an Addisonian crisis.
  • Paraesthesia and pain may follow intravenous injection.
 
 
Hydrocortisone Granules (Alkindi®)
(Granules in capsules for opening)
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Formulary
Green plus

0.5mg, 1mg, 2mg & 5mg

  • approved for treatment of adrenal insufficiency in infants, children and adolescents 
  • patients should be transitioned onto tablets once they are able to take them

 

 
Link  MHRA Drug Safety Update (Feb 2021): Alkindi (hydrocortisone granules): risk of acute adrenal insufficiency in children when switching from hydrocortisone tablet formulations to granules
 
Dexamethasone
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Alternatives
Green
  • 500microgram & 2mg tablets
  • 500microgram soluble tablets
  • 2mg in 5ml oral solution and 5mg in 5ml oral solution  is also approved. unlicensedunlicensed
  • 20mg/5ml oral solution Red
  • Approved for use in patients requiring high dose to reduce pill burden
 
Link  MHRA Alert (Oct 2014): Dexamethasone 4 mg/ml injection (Organon Laboratories Limited): reformulation with changes in name, concentration, storage conditions, and presentation
 
Methylprednisolone sodium succinate 2mg, 4mg, and 16mg (tablets)
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Alternatives
Green
 
 
Dexamethasone 3.3mg in 1ml and 6.6mg in 2ml
(injection )
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Alternatives
Green
  • Note: there are two different strength preparations of dexamethasone injection available in the UK (3.8mg/ml and 3.3mg/ml) where traditionaly a 4mg/ml preparation was available and prescribed as such. To avoid confusion the 3.3mg/ml strength is the preparation of choice in the acute Trusts. Where previously a 4mg dose would have prescribed it is appropriate to prescribe a 3.3mg dose (or multiples thereof). This is because the range of doses given in clinical practice varies widely and subsequent doses tend to be adjusted to reflect clinical response. If 4mg is required please ensure that the appropriate volume of 3.3mg/ml is (e.g. 1.2ml) prescribed (or mulitples thereof).
 
 
Hydrocortisone
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Alternatives
Green
  • 10mg and 20mg tablets Green
  • 2.5mg buccal tablets Green
  • 10mg in 5ml suspension unlicensedunlicensed.Green


 
 
Methylprednisolone Acetate 40mgin 1ml and 120mg in 3ml (depot)
(injection)
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Alternatives
Green
 
 
Methylprednisolone sodium succinate 40mg, 125mg, 500mg & 1000mg (injection)
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Alternatives
Green
 
Link  MHRA Drug Safety Alert (Oct 2017): Methylprednisolone injectable medicine containing lactose (Solu-Medrone 40 mg): do not use in patients with cows’ milk allergy 
Link  NICE NG220: Multiple sclerosis in adults: management
 
Triamcinolone acetonide 40 mg in 1ml
(Intramuscular/intra-articular injection)
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Betamethasone 4mg in 1ml
(injection)
View adult BNF View SPC online View childrens BNF
Alternatives
Red
 
 
Hydrocortisone
(Solution)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Green

  • 10mg/5ml oral solution

 
 
06.03.02  Disadvantages of corticosteroids
06.03.02  Use of corticosteroids
06.03.02  Pregnancy and breastfeeding
06.03.02  Administration
06.03.02  Withdrawal of corticosteroids to top
06.04  Sex hormones
06.04.01  Female sex hormones and their modulators
06.04.01.01  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  Hormone replacement therapy
06.04.01.01  Ethinylestradiol to top
06.04.01.01  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  Oestrogen only tablets
06.04.01.01  Oestrogens and progestogen sequential combined therapy
06.04.01.01  Continuous combined therapy
06.04.01.01  Gonadomimetic to top
06.04.01.01  Selective oestrogen modulator
06.04.01.02  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  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 50mg in 5gram (1%) gel (Testim®)
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • For use on advice of an endocrinologist.
 
Link  NENC ICB - Management of the Menopause
 
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) and 2.5g sachets (40.5mg/2.5g).
  • Approved for hypogonadism Green plus
    • For use on advice of an endocrinologist.
  • 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 10mg in 0.5ml (2%)/metered dose (Tostran®)
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • For use on advice of an endocrinologist.
 
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
 
Link  NENC ICB - Management of the Menopause
 
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  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  Anabolic steroids to top
06.04.04  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

 
 
06.05  Hypothalamic and pituitary hormones and anti-oestrogens
06.05.01  Hypothalamic and anterior pituitary hormones and anti-oestrogens
Follitropin delta (Rekovelle®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved for patients at risk of ovarian hyper stimulation syndrome (OHSS).

 

 
 
06.05.01  Anti-oestrogens
Clomifene Citrate
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
06.05.01  Anterior pituitary hormones to top
Tetracosactide (Synacthen®)
(Corticotrophin)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Approved formulations include:
    • 250microgram in 1ml injection;
    • 1mg in 1ml depot injection. 

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

  •   Fertility treatment Red Traffic Light

  •   Hypogonadism Green Traffic Light

 
 
Lutropin Alfa
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Menotrophin (75 units FSH & 75 units LH activity) injection
(Gonadotrophin)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Pegvisomant (Somavert®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
 
SomatrogonBlack Triangle (Ngenla®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
CCG

24mg and 60mg solution for injection in pre-filled pen

 
Link  NICE TA863: Somatrogon for treating growth disturbance in children and young people aged 3 years and over
 
Somatropin (children)
(Growth hormone - children)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • First line
  • Omnitrope® 5-mg (15-unit) vial (powder with diluent) for use with Omnitrope Pen L® device, 3.3 mg (10 units)/ml, 1.5 ml (5-mg, 15-unit) cartridge & 6.7 mg (20 units)/ml, 1.5 ml (10-mg, 30-unit) cartridge - for use with Omnitrope Pen 5® & Omnitrope Pen 10® devices respectively. 
  • Note: Omnitrope is the least expensive formulation of somatropin and should be used in all de novo paediatric patients where possible. 
  • Second line 
  • Norditropin SimpleXx® 1.5ml cartridges for use in Nordipen® devices - 5mg (15 units), 10mg (30 units) and 15mg (45 units). Note: norditropin is the second least expensive alternative formulation for patients who cannot tolerate omnitrope. 
  • Saizen® 8mg vials (powder with diluent), Saizen® 5.83 mg/ml solution for injection (6mg cartridges), 8 mg/ml solution for injection (12mg and 20mg cartridges) - for use in EasyPod® device (to be used in patients with compliance issues).
  • Third line
  • Genotropin Miniquick® syringes - 0.2mg (0.6 units) 0.8mg (2.4 units) 1.4mg (4.2 units), 0.4mg (1.2 units) 1mg (3 units) 1.6mg (4.8 units) 0.6mg (1.8 units), 1.2mg (3.6 units) 2mg (6 units). To be used for patients when travelling.
  • Zomacton® (needle free presentation) 12 unit (4mg) injection; 1st line: 75% to 85% of total mg usage; 2nd line: 15% to 25% of total mg usage; 3rd line: up to 5% of total mg usage.
 
Link  NICE TA188: Human growth hormone (somatropin) for the treatment of growth failure in children
 
Somatropin - adults
(Growth hormone - adults)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Genotropin® cartridges for use in Genotropin pens - 16 unit (5.3mg) & 36 unit (12mg) in 1ml. 
  • Genotropin Miniquick® syringes - 0.2mg (0.6 units), 0.8mg (2.4 units), 1.4mg (4.2 units) 0.4mg (1.2 units) 1mg (3 units) 1.6mg (4.8 units) 0.6mg (1.8 units) 1.2mg (3.6 units) 2mg (6 units) - to be used for patients when travelling.
 
Link  NICE TA64: Human growth hormone (somatropin) in adults with growth hormone deficiency
 
Follitropin Alfa
(Recombinant human follicle stimulating hormone)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
06.05.01  Hypothalmic hormones
Gonadorelin 100microgram in 1ml
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Protirelin (TRH)
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
 
 
06.05.02  Posterior pituitary hormones and antagonists
Tolvaptan
(vasopressin V2-receptor antagonist)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
  • 15mg, 30mg, 45mg, 60mg and 90mg tablets (Jinarc®) - approved for the treatment of autosomal dominant polycystic kidney disease in line with NICE.
  • 15mg and 30mg tablets (Samsca®) - approved for the treatment of hyponatraemia secondary to the Syndrome of Inappropriate Antidiuretic Hormone (SIADH) in patients requiring cancer chemotherapy in accordance with NHS England Policy.
 
Link  NICE TA358: Autosomal dominant polycystic kidney disease - tolvaptan
 
06.05.02  Posterior pituitary hormones
Argipressin 20units in 1ml injection
(Synthetic vasopressin)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Desmopressin
View adult BNF View SPC online View childrens BNF
Formulary
Green
  • The following desmopressin  formualtions are approved for use:
    • 10 microgram/dose nasal spray.
    •  2.5 & 150 microgram/dose nasal sprays Red Traffic Light(unlicensedunlicensed).
    • 100 microgram & 200 microgram tablets.
    • 120 microgram sublingual tablets.
    •  4 microgram in 1ml injection and 15 microgram in 1ml injectionRed Traffic Light
 
 
Terlipressin 1mg injection
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
Link  MHRA Drug Safety Update (March 2023): Terlipressin: new recommendations to reduce risks of respiratory failure and septic shock in patients with type 1 hepatorenal syndrome
 
06.05.02  Antidiuretic hormone antagonists
Demeclocycline
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • 150mg capsules
    • Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
      Treatment to be intitated by specialist.
 
 
06.06  Drugs affecting bone metabolism to top
06.06  Osteoporosis
06.06.01  Calcitonin and parathyroid hormone
Calcitonin 400units in 2ml
(Salcatonin Injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Teriparatide 250microgram in 1ml prefilled pen (Biosimilar brands - Movymia®,Terrosa® & Teva)
View adult BNF View SPC online View childrens BNF
Formulary
Red

  • Approved for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis primary in line with NICE.**All new patients**

  • Approved for the treatment of osteoporosis in males and juveniles in line with NHSE Commissioning Policy

 
Link  Biosimilar teriparatide for the treatment of osteoporosis in postmenopausal women as per NICE TA161.
Link  NICE TA160: Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women
Link  NICE TA161: Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
 
Teriparatide 250microgram in 1ml prefilled pen (Forsteo®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

  • Approved for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis primary in line with NICE. **Exisiting patients only**

  • Approved for the treatment of osteoporosis in males and juveniles in line with NHSE Commissioning Policy

 
Link  NICE TA160: Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women
Link  NICE TA161: Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
 
06.06.02  Bisphosphonates and other drugs affecting bone metabolism
Burosumab  (Crysvita®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

  • 10mg, 20mg & 30mg solution for injection

  • Approved for treating X-linked hypophosphataemia in children and young people in accordance with NICE

 
Link  NICE HST 8: Burosumab for treating X-linked hypophosphataemia in children and young people
 
06.06.02  Bisphosphonates
Alendronic Acid
(osteoporosis)
View adult BNF View SPC online View childrens BNF
First Choice
Green
  • Approved alendronic acid formulations include:
    • 10mg tablets (taken daily)
    • 70mg tablets (taken once weekly) – preferred
    • 70mg effervescent tablets (Binosto®) - for use only in patients with documented swallowing difficulties

  • Alendronic acid is approved for the primary prevention of osteoporosis in postmenopausal women in line with NICE
  • Approved for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis primary in line with NICE.
  • Approved for the treatment of osteoporosis in line with NICE
 
Disodium Pamidronate 30mg injection
(hypercalcaemia)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Ibandronic Acid
(osteoporosis)
View adult BNF View SPC online View childrens BNF
Alternatives

  • Ibandronic acid 50mg tablets are approved for use in the reduction of bone damage in patients with metastatic breast cancer. Not approved for use in the treatment of patients with other forms of cancer (e.g. prostate). Green plus  

  • Ibandronic acid 150mg tablets are approved for the treatment of osteoporosis in line with NICE Green

  • Ibandronic acid 3mg in 3ml injection is approved for use where oral bisphosphonates are not appropriate (not tolerated, contra-indicated because of upper gastro-intestinal problems or insufficiently effective) Red

 
Link  NICE TA464 Bisphosphonates for treating osteoporosis
 
Risedronate
(Osteoporosis/Paget's)
View adult BNF View SPC online View childrens BNF
Alternatives
Green
  • Approved risedronate formulations include:
    • 5mg tablets (taken daily);
    • 35mg tablets (taken once weekly for osteoporosis) -preferred.

  • Risedronate is approved for the primary prevention of osteoporosis in line with NICE, and for for the secondary prevention of osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis in line with NICE. 
  • Risedronate 30mg tablets are also approved for Paget’s disease.
  • Approved for the treatment of osteoporosis in line with NICE
 
Link  NICE TA464 Bisphosphonates for treating osteoporosis
 
Sodium Clodronate
(Hypercalcaemia)
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • 520mg and 800mg tablets
 
 
Zoledronic Acid 4mg injection
(Hypercalcaemia/breast cancer)
View adult BNF View SPC online View childrens BNF
Alternatives
Red
  • Approved for use in treating hypercalcaemia of malignancy and the prevention of skeletal events in patients with metastatic breast cancer.
  • Approved for the adjuvant treatment of post-menopausal  women with early breast cancer (subject to agreement with the CCGs and provider trusts regarding the extra activity). 
  • Not approved for preventing skeletal events in patients with prostate cancer.
  • To avoid confusion it is recommended that this product is prescribed by brand name i.e. Zometa®
 
 
Zoledronic Acid 5mg injection
(Osteoporosis/Paget's)
View adult BNF View SPC online View childrens BNF
Alternatives
Red
  • Prescribe by brand name
  • Approved for the treatment of osteoporosis in line with NICE
 
Link  NICE TA464 Bisphosphonates for treating osteoporosis
 
06.06.02  Denosumab to top
Denosumab (Xgeva®)
(Metastases)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • Denosumab 70mg in 1ml (120mg) vial is approved for the prevention of skeletal-related events in adults with bone metastases from solid tumours in line with NICE 
    • Note: denosumab is not approved for therapy induced bone loss in non- metastatic prostate cancer (NICE).


  • North Cumbria only
    • New patients        Red
    • Exisiting patients  Green plus
 
Link  MHRA Drug Safety Updates: Denosumab
Link  NICE TA265: Bone metastases from solid tumours - denosumab: guidance
 
Denosumab (Prolia®)
(Osteoporosis)
View adult BNF View SPC online View childrens BNF
Alternatives
Amber
  • Denosumab 60mg in 1ml solution in prefilled syringe is approved for use in the treatment of postmenopausal osteoporosis in line with NICE. Also approved for male patients who dont tolerate bisphosphonates or strontium ranelate. 

 

 
Link  NICE TA204: Osteoporotic fractures - denosumab
Link  MHRA Drug Safety Updates: Denosumab
Link  North of Tyne, Gateshead and North Cumbria: DENOSUMAB (Prolia®) 60mg sc twice yearly for osteoporosis Information for Treatment of Adults in Primary Care
Link  CD&TV APC Information sheet to support prescribing and monitoring of Denosumab (Prolia®
 
06.06.02  Strontium renelate
Strontium Ranelate
(Sachets)
View adult BNF View SPC online View childrens BNF
Formulary
Red

  • Treatment of severe osteoporosis

    • in post menopausal women and adult men at high risk of fracture, for whom treatment with other medicinal products approved for the treatment of osteoporosis is not possible due to, for example, contraindications or intolerance.



 
 
06.06.02  Romosozumab
RomosozumabBlack Triangle (Evenity ®)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red
CCG
  • Approved for severe osteoporosis in people after menopause who are at high risk of fracture in line with NICE.
 
Link  NICE TA791: Romosozumab for treating severe osteoporosis
 
06.07  Other endocrine drugs
Ketoconazole (Ketoconazole HRA)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Tablets: 200mg

Indication: Cushing's Syndrome 

 
 
SetmelanotideBlack Triangle (Imcivree®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England

10mg/1ml vial for injection

 
Link  NICE HST21: Setmelanotide for treating obesity caused by LEPR or POMC deficiency
 
06.07.01  Bromocriptine and other dopaminergic drugs
Bromocriptine 2.5mg tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Cabergoline 500microgram and 1mg tablets
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
Quinagolide
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
 
 
06.07.02  Drugs affecting gonadotrophins to top
 note 

Northern Region Gender Dysphoria Service

General Guidelines For The Use Of Hormone Treatment In Gender Dysphoria

Leuprorelin
View adult BNF View SPC online View childrens BNF
First Choice
Green plus
  • Approved formualtions include 3.75mg and 11.25mg pre filled syringes (also see section 8.3.4.2).
 
Relugolix–estradiol–norethisterone acetate (Ryeqo®)
View adult BNF View SPC online View childrens BNF
Formulary
Green plus
  • Approved as an option for treating moderate to severe symptoms of uterine fibroids in adults of reproductive age - in line with NICE TA832.
 
Link  NICE TA832: Relugolix–estradiol–norethisterone acetate for treating moderate to severe symptoms of uterine fibroids
 
Buserelin 150microgram nasal spray
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Cetrorelix
View adult BNF View SPC online View childrens BNF
Alternatives
Red
 
 
Danazol 100mg and 200mg capsules
View adult BNF View SPC online View childrens BNF
Alternatives
Green
 
 
Goserelin
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • The following goserelin formulations are approved for use 3.6mg & 10.8mg injections (also see section 8.3.4.2). 
  • Note: leuprorelin is now substantially less expensive than goserelin
 
 
Nafarelin
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
 
 
Triptorelin
View adult BNF View SPC online View childrens BNF
Alternatives
Green plus
  • The following formulations are approved for use in treating precocious puberty:
    • Gonapeptyl Depot® 3.75mg injection;
    • Decapeptyl SR®11.25mg injection.

  • Refer to Chapter 8 - Gonadorelin analogues for the treatment of prostate cancer. The following strengths are approved:
    • 3mg, 11.25mg and 22.5mg

 

 
 
06.07.02  Gonadorelin analogues
06.07.02  Breast pain (mastalgia)
06.07.03  Metyrapone
Metyrapone (Metopirone®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
  • 250mg capsules
 
 
06.07.04  Somatomedins
MecaserminBlack Triangle (Increlex®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
 
Link  MHRA Drug Safety Update (Jan 2020): Mecasermin (Increlex▼): risk of benign and malignant neoplasia
 
06.08  Metreleptin to top
Metreleptin
View adult BNF View SPC online View childrens BNF
Formulary
Red
High Cost Medicine
NHS England

  • 3mg, 5.5mg and 11.3mg powder for solution for injection



  • Approved for treating lipodystrophy in children and adults in line with NICE

 
Link  NICE HST14: Metreleptin for treating lipodystrophy
 
 ....
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