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Ipswich and East Suffolk CCG
North East Essex CCG
East Suffolk and North East Essex NHS Foundation Trust
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 Formulary Chapter 6: Endocrine system - Full Chapter
06.01  Drugs used in diabetes
 note 

Hospital only guidance

06.01.01  Insulins
 note 

Adults who are using insulin therapy should receive a patient information booklet and an Insulin Passport

 

PSA-Risk of severe harm and death due to withdrawing insulin from pen devices

06.01.01.01  Short-acting insulins
Insulin (Insuman® Rapid)
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Restricted Drug Restricted

Ipswich Hospital

Soluble insulin (Insuman) is considered a non-formulary medicine

Colchester Hospital

Soluble insulin (Insuman) is considered a formulary medicine; albeit with very limited use in practice. Treatment would not usually be initiated within the acute hospital

 

NEECCG

Considered a formulary medicine

 
   
Insulin Glulisine (Apidra®)
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Restricted Drug Restricted

Ipswich Hospital

Insulin glulisine is a non-formulary medicine

Colchester Hospital

Insulin glulisine is considered a formulary medicine, although it is not commonly used in practice and treatment must be initiated by the hospital's Diabetes Team

 

NEECCG

Considered a formulary medicine

 

 

 
   
Insulin Lispro 200 units/ml (Humalog®)
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Restricted Drug Restricted

Ipswich Hospital

Insulin Lispro 200units/ml is considered a non-formulary medicine

Colchester Hospital

Insulin Lispro 200units/ml is considered a formulary medicine, but with very restricted usage. Only for patients requiring high doses of insulin therapy; to decrease injection volume load

NEECCG

Considered a formulary medicine

 
   
06.01.01.01  Soluble insulin
Actrapid®
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First Choice
Green

Soluble insulin - first line use within the acute Trust - not for routine use within Primary Care


Available as

  • Vials
 
Humulin® S
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Formulary
Green

Soluble insulin


Available as:

  • Vials
  • Cartridges
 
   
06.01.01.01  Ultra-Rapid acting insulin analogues to top
Fiasp® (Insulin Aspart )
(Rapid acting insulin anologue)
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Formulary
Green

Rapid acting insulin anologue

Note : Faster acting than Novorapid


Available as:

  • Vials
  • Cartridges
  • Flextouch® Pre-filled pen
 
   
06.01.01.01  Short-acting human insulin analogues
NovoRapid® (Insulin Aspart )
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First Choice
Green

Rapid acting insulin anologue- First line


Available as:

  • Vials
  • Cartridges
  • Flexpen ( pre-filled pen)
 
Humalog® (Insulin Lispro )
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Formulary
Green

Rapid acting insulin analogues


Available as:

  • Vials
  • Cartridges
 
   
06.01.01.02  Intermediate- and long-acting insulins
 note 

Insulin glargine preparations are not interchangeable

For new initiations of glargine- use Semglee

Insulatard® (Isophane Insulin )
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First Choice
Green

Basal Insulin-First Line


Available as:

  • Cartridges
  • Innolet device
 
Semglee® (Insulin glargine )
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Formulary
Green

For new initiations for patients requiring glargine


Available as:

  • Pre-filled pens
 
   
Abasaglar® (Insulin glargine )
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Formulary
Green

Basal insulin


Available as:

  • Cartridges
  • Kwikpen

Note - within North East Essex CCG, the use of biosimilar glargine Semglee has also been approved for use

 
   
Lantus® (Insulin Glargine)
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Formulary
Green

Basal insulin

For continuation only


Available as:

  • Cartridges
  • Vials
  • Solostar pre filed pen
 
   
Toujeo® (Insulin Glargine )
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Formulary
Green

Basal insulin


Available as:

  • Solostar® pre filled pen

Red Triangle Caution-High strength:300 units/ml - to be used only in patients requiring high doses of insulin therapy; to decrease injection volume load

 
   
Levemir® (Insulin Detemir)
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Formulary
Green

Basal insulin


Available as:

  • Cartridges
  • Flexpen pre-filled pen
 
   
Xultophy® (Insulin degludec and liraglutide)
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Formulary
Green

Basal insulin with GLP-1 anologue

 
   
Tresiba® (Insulin degludec )
(100 units/ml)
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Formulary
Green

Basal insulin


Available as:

  • Cartridges
  • FlexTouch pre-filled pen
 
   
Insulin degludec (Tresiba®)
(200 units/ml)
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Restricted Drug Restricted

Ipswich Hospital

Insulin degludec (Tresiba) 200units/ml is a non-formulary medicine

Colchester Hospital

Insulin degludec (Tresiba) 200units/ml is a formulary medicine - but very restricted use; only for patients requiring high doses of insulin therapy to decrease injection volume load

 
   
06.01.01.02  Biphasic insulins
Humulin® M3
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First Choice
Green

Isophane Insulin human


Available as:

  • Cartridges
  • Solostar® Pre-filled pen
  • Vials
 
NovoMix® 30
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Formulary
Green

Biphasic Insulin Aspart


Available as:

  • Cartridges
  • Flexpen® pre-filled pen
 
   
Humalog® Mix
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Formulary
Green

Biphasic Insulin Lispro


Available as:

  • Cartridges
  • Pre-filled pen
 
   
Lyumjev® Mix
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Formulary
Green

Insulin Lispro


Available as:

  • Pre-filled pen
  • Cartridges- rarely used across East Suffolk and North East Essex

 

Please prescribe by brand.

Note: this is not directly interchangable with other Insulin Lispro formulations as it has different pharmodynamic properties. 

 
   
Biphasic Isophane Insulin (Insuman® Comb)
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Restricted Drug Restricted

Ipswich Hospital

Isophane insulin (Insuman Comb) is a non-formulary medicine

Colchester Hospital

Isophane insulin (Insuman Comb) is considered a formulary medicine; albeit with very limited usage. Treatment is unlikely to be initiated within the acute hospital.

 

NEECCG

Considered a formulary medicine

 

 
   
06.01.01.03  Hypodermic equipment
06.01.01.03  Needles to top
GlucoRx Carepoint ®
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Formulary
Blue

Primary care guidance

Available as

  • 4mm/31 gauge
  • 5mm/31 gauge
  • 6mm/31 gauge
  • 8mm/31 gauge
  • 10mm/29 gauge
  • 12mm/29 gauge
 
   
GlucoRx Carepoint Ultra ®
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Formulary
Blue

Primary care guidance

Available as

    • 4mm/32 gauge

Please note: GlucoRx Carepoint Ultra needle has a higher gauge in the 4mm length than the standard needle. As a result, patients may experience less discomfort when injecting.

 
   
06.01.01.03  Lancets
Lancets
Formulary
Blue

Primary care guidance

Only prescribe lancets which cost less than £3 per 100 lancets

See below for formulary choices

Options include

  • Advocate®
  • Agamatrix®;
  • Apollo twist®
  • Caresens®
  • Droplet®
  • FastClix®
  • GlucoRx®
  • GlucoZen®
  • GreenLan®
  • IME-DC®
  • Microdot®
  • Millward Steri-Let®
  • Mylife lancets®
  • Mylife multicolour®
  • Omnican Lance Soft®
  • OneTouch Delica®
  • Palmdoc Lancets®
  • Palmdoc iCare Advanced®
  • TRUEplus Lancets®
  • Vitrex soft®
 
   
06.01.02  Antidiabetic drugs
06.01.02.01  Sulphonyureas
Gliclazide
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Formulary
Blue

Ipswich Hospital

Note-modified release preparation of gliclazide is not approved

Gliclazide 30mg MR release is approximately equivalent to gliclazide 80mg standard release. 

Note: To ensure adequate distribution of gliclazide levels over 24 hours, when switching from modified release to standard release gliclazide, use the following equivalent dosing:

30mg once daily gliclazide MR= 40mg twice daily gliclazide standard release

60mg once daily gliclazide MR= 80mg twice daily gliclazide standard release

Switching doses of gliclazide MR over 60mg daily to standard release gliclazide should be discussed with the Ipswich Hospital diabetes team

 

 
   
Glimepiride
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Formulary
Blue
 
   
Gliclazide MR
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Restricted Drug Restricted

Ipswich Hospital

Gliclazide m/r is a non-formulary medicine and a switch process is in place within the acute hospital to change patients to the normal release formulation

Colchester Hospital

Gliclazide m/r is considered a formulary medicine; it is unlikely that treatment would be initiated within the acute hospital but existing treatment would be continued if clinically appropriate. There is no formal switch process in place.

NEECCG

Considered a formulary medicine

 
Link  IHT- Therapeutic Substitution Register
   
06.01.02.02  Biguanides
Metformin
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Formulary
Blue

Available as 

  • Tablets
  • 500mg/ml liquid
 
   
Metformin modified release
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Formulary
Blue

Prescribe only if intollerent to stardard release metformin

 
   
06.01.02.03  Other antidiabetic drugs to top
06.01.02.03  Alpha glucosidase inhibitors
06.01.02.03  DPP4 inhibitors (gliptins)
AlogliptinBlack Triangle
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First Choice
Blue

First choice for new initiations


Not licensed for monotherapy

 
Saxagliptin
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Formulary
Blue

For treatment continuation or new initiations requiring monotherapy

 
   
LinagliptinBlack Triangle
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Formulary
Blue

Reserved for patients with fluctuating renal function 

 
   
Sitagliptin (Januvia®)
(DPP4 inhibitor)
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Restricted Drug Restricted

Treatment would not usually be initiated within the acute Trust - existing treatment would be continued on if appropriate

 
   
06.01.02.03  GLP1 agonists
 note 

MHRA:Reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

Dulaglutide
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Formulary
Blue
 
Link  East Suffolk and North Essex GLP-1Ra Pathway
   
Exenatide prolonged releaseBlack Triangle (Bydureon®)
(GLP1 agonist)
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Formulary
Green

Not for new initiations, treatment continuation only

 
Link  East Suffolk and North Essex GLP-1Ra Pathway
Link  NICE TA248: MR exenatide
   
SemaglutideBlack Triangle (Omzempic)
(injection)
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Formulary
Green

Initial supply of 4 weeks to be made by the hospital with extra information provided to the patient by the specialist (see below)

 
Link  East Suffolk and North Essex GLP-1Ra Pathway
Link  Semaglutide - Patient information leaflet
   
Semaglutide (Oral)Black Triangle (Rybelsus)
(3mg, 7mg and 14 mg tablets)
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Formulary
Blue
 
Link  East Suffolk and North Essex GLP-1Ra Pathway
Link  Primary care Information Sheet for Rybelsus® (Oral Semaglutide)
   
Victoza® (Liraglutide )
(GLP1 agonist)
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Formulary
Blue

Must be prescribed by brand

 
Link  East Suffolk and North Essex GLP-1Ra Pathway
Link  NG28: Type 2 diabetes in adults: management
   
Exenatide (Byetta▼®)
(GLP1 agonist)
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Restricted Drug Restricted

Ipswich Hospital

Exenatide is considered non-formulary

Colchester Hospital

Exenatide is considered a formulary medicine; although rarely used and with treatment initiation by a Consultant Endocrinologist only

 
Link  East Suffolk and North Essex GLP-1Ra Pathway
   
LixisenatideBlack Triangle
(GLP1 agonist)
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Restricted Drug Restricted

Ipswich Hospital/IESCCG

Lixisenatide is considered non-formulary

Colchester Hospital/NEECCG

Lixisenatide is considered a formulary medicine

 
Link  East Suffolk and North Essex GLP-1Ra Pathway
   
06.01.02.03  Meglitinides
Nateglinide
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Formulary
Green
 
   
06.01.02.03  SGLT-2 inhibitors to top
 note 

MHRA:Risk of diabetic ketoacidosis

MHRA:Increased risk of lower-limb amputation (mainly toes)

MHRA:Reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)

 

Dapagliflozin
(SGLT-2 inhibitor)
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Formulary
Blue
 
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 TA597 Dapagliflozin with insulin for treating type 1 diabetes
   
ErtugliflozinBlack Triangle (Steglatro)
(Tablets)
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Restricted Drug Restricted
Green

Ipswich diabetes consultants prefer other choices in this class of drugs.  Awaiting cardiovascular outcome data.

 
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
   
EmpagliflozinBlack Triangle
(SGLT-2 inhibitor)
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Formulary
Blue
 
Link  NICE TA336: Empagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
   
CanagliflozinBlack Triangle
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Formulary
Blue
 
Link  NICE TA315: Canagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
   
06.01.02.03  Thiazolidinediones
Pioglitazone
(Thiazolidinedione)
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Restricted Drug Restricted

MHRA:Risk of cardiac failure

MHRA:Risk of bladder cancer

In view of the above MHRA alerts, the use of pioglitazone treatment is limited. New patients should ideally not be initiated on therapy; existing patients will continue treatment after appropriate clinical review. 

 
   
06.01.03  Diabetic ketoacidosis
06.01.04  Treatment of hypoglycaemia
Glucagon (GlucaGen® HypoKit)
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Formulary
Blue

1 unit is equivalent to 1mg

 
   
Glucose 20% 100ml infusion
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Formulary
Red Hospital

Hospital use only

 
   
Glucose 40% oral gel
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Formulary
Red Hospital

Padiatric inpatient use only

 
   
Glucose power
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Formulary
Red Hospital

Hospital inpatient use only

 
   
06.01.04  Chronic hypoglycaemia
Diazoxide
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Restricted Drug Restricted
Green

Ipswich Hospital

Diazoxide is considered a formulary medicine; Specialist initiation only

Colchester Hospital

Diazoxide is considered a non-formulary medicine

 
   
06.01.05  Treatment of diabetic nephropathy and neuropathy to top
06.01.06  Diagnostic and monitoring agents for diabetes mellitus
 note 

Primary care guidance

 
 
06.01.06  Oral glucose tolerance test
Polycal ®
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Formulary  
   
06.01.06  Flash Glucose monitoring
Freestyle Libre
View adult BNF
Formulary
Green

IESCCG

Only to be prescribed by GP following a recommendation by the diabetes team at Ipswich hospital

Patients eligible for Freestyle Libre will be reviewed at 6 months by the specialist and then at 6-12 month intervals 

GPs are recommended to prescribe no more than 2 sensors (28 days) 

Please see links below for further information

 

NEECCG

See link to policy below.

 
Link  IESCCG Freestyle Libre Position statement and patient information leaflet
Link  NEECCG Freestyle libre Prescribing policy
   
06.01.06  Blood glucose meters-all patients with Type 2 Diabetes and all patients with Type 1
 note 

These meters should be used unless the patient meets the specific criteria listed in the other categories

GlucoRx Q meter
First Choice
Blue

Compatible strips

  • Gluco Rx Q® Test Strips
 
FineTest Lite
First Choice
Blue

Compatible strips

  • FineTest Lite Blood Glucose Test Strips
 
Accu-chek Performa Nano
Formulary
Blue

Compatible strips

  • Accu-chek Performa Test strips
 
   
TEE 2+
Formulary
Blue

Compatible strips

  • TEE 2 test strips
 
   
06.01.06  Blood Ketone Meters – Used in Type 1 Diabetes Only to top
CareSens Dual meter
First Choice
Blue

Only for Type I DM patients requiring tests for both blood glucose and ketones in one meter


Compatible test strips

  • CareSens Pro test strips
  • KetoSens Ketone test strips
 
KEYA Smart Blood glucose and ketone meter
Formulary
Green

Hospital recommendation only
Measures glucose and ketones in one strip


Compatible test strips

  • KEYA test strips
 
   
06.01.06  Higher-cost Test Strips that CAN ONLY BE PRESCRIBED IN SPECIFIC CIRCUMSTANCES
Accu-chek Mobile
Formulary
Blue

For users of Heavy Goods Vehicle (HGV) drivers due to ease of use on long journeys and device is DVLA memory storage compliant.

Compatible test strips


  • Accu-Chek Mobile Test Cassette
 
   
Contour Next Link meter
Formulary
Green

Only for Type I DM patients using a Medtronic insulin pump, communicates with the pump via Bluetooth®.


Compatible test strips

  • Contour Next strips
 
   
Accu-chek Aviva Expert meter
Formulary
Green

Hospital recommendation only-  Bolus Advisor


Compatible test strips

  • Accu-chek Aviva Plus strips
 
   
Freestyle Optium Neo meter
Formulary
Green

Antenatal use only


Compatible test strips

  • Freestyle Optium strips
 
   
Freestyle Freedom Lite
Formulary
Green

Omnipod Insulet pump handset/meter. Doubles as a meter and bolus advisor.


Compatible test strips

  • Freestyle lite strips
 
   
Accu-chek Aviva Expert meter
Formulary
Green

Only for Type 1 DM patients using a FreeStyle Accu-Chek Combo / Accu-Chek Insight Insulin Pump


Compatible test strips

  • Accu-chek Aviva strips
 
   
06.01.06  Talking blood glucose meters
GlucoRx Nexus Voice
First Choice
Blue

For patients with visual impairments


Compatible test strips

  • GlucoRx Nexus strips
 
06.02  Thyroid and Antithyroid drugs
06.02.01  Thyroid hormones
Levothyroxine
(Thyroxine)
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Formulary
Blue

Note: levothyroxine liquid is very expensive compard to oral tablet therapy and so must only be prescribed in justifiable circumstances

 
   
Liothyronine tabs
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Restricted Drug Restricted
Green
High Cost Medicine

Joint guidance

Note: Armour thyroid must never be prescribed

Liothyronine is classed as medicine of low clinical value by NHSE
Initiation
Liothyronine is only to be used following a successful 3 month trial by an endocrinology consultant. Please see below for further guidance
Existing patients
Existing patients should be screened by endocrinology to determine the suitability of continuing liothyronine. GP should fill out the questionnaire( see below) and send it to the endocrine team for review who will advise the GP of the next steps.
 
Link  IESCCG liothyronine prescribing advice and GP questionnaire
   
Liothyronine injection
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Restricted Drug Restricted
Red Hospital
High Cost Medicine

Very speciailist use - only utilised within the Critical Care setting as part of agreed organ donor optimisation pathways

 

 

 
   
06.02.02  Antithyroid drugs to top
Carbimazole
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Formulary
Green

MHRA:Increased risk of congenital malformations; strengthened advice on contraception

MHRA:Risk of acute pancreatitis

 
   
Propylthiouracil
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Formulary
Green
 
   
Lugols
(Aqueous iodine oral solution)
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Formulary
Red Hospital
 
   
06.03  Corticosteroids
06.03.01  Replacement therapy
Fludrocortisone
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Formulary
Blue
 
   
06.03.02  Glucocorticoid therapy
Prednisolone (tablets)
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Formulary
Blue

Enteric coated tablets are not approved for use within the acute Trust and throughout the CCGs

Prednisolone 25mg tablets are not approved for routine use (due to high cost) but may be utilised in rare patients requiring daily doses of 50mg daily (or more) to reduce tablet load

Prednisolone soluble tablets are considered non-formulary due to their high cost and the fact that normal prednislone tablets can be crushed and dispersed to good effect

 
Link  IHT- Therapeutic Substitution Register
   
Dexamethasone (injection)
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Formulary
Red Hospital

Hospital only guidance

Prescribe dexamethasone as 3.3mg (1ml dose) or 6.6mg (2ml dose) except for Oncology / Haematology protocols where the 4mg dose may be more appropriate.

See below for IHT newsletter

 
Link  IHT newsletter- Dexamethasone injection
   
Dexamethasone  (tabs/ dispersible tabs)
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Formulary
Blue
 
   
Hydrocortisone
(tablets)
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Formulary
Blue

Modified release tablets are not approved

 
   
Hydrocortisone sodium phosphate (Efcortesol® injection)
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Formulary
Red Hospital

Already in solution

 
   
Hydrocortisone sodium succinate (Solu-Cortef® injection)
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Formulary
Red Hospital

Requires reconstitution

 
   
Hydrocortisone MR (Plenadren)
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Restricted Drug Restricted
Double Red

Ipswich Hospital - Used only following an individual funding request by Ipswich Hospital endocrinologist, approved by CCG.

Colchester Hospital - product is completely Non-Formulary

 
   
Betamethasone (Betnesol®)
(injection - systemic)
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Formulary
Red Hospital
 
   
Methylprednisolone (tabs)
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Formulary
Red Hospital

For use in MS relapse

 
Link  NICE CG186: Multiple Sclerosis; management in primary and secondary care.
   
Triamcinolone acetonide (intra-articular/ intramuscular injection)
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Formulary
Red Hospital

Hospital only guidance

Indications

For adult use only.
Unlicensed use for patients with complications post breast reconstruction surgery

 
   
Triamcinolone hexacetonide  (injection)
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Formulary
Red Hospital

For paediatric use only 

 
   
06.03.02  Disadvantages of corticosteroids
06.03.02  Use of corticosteroids to top
06.03.02  Pregnancy and breastfeeding
06.03.02  Administration
06.03.02  Withdrawal of corticosteroids
06.04  Sex hormones
06.04.01.01  Oestrogens and HRT to top
 note 

MHRA:Further information on the known increased risk of breast cancer with HRT and its persistence after stopping

Combined continuous HRT patch (Evorel® Conti)
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Formulary
Blue
 
   
Combined cyclical HRT patch (Evorel® Sequi)
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Formulary
Blue
 
   
Oestrogen only HRT patch (Estradot, Evorel)
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Formulary
Blue
 
   
Oestrogen only HRT tablet (Elleste-Solo, Premarin)
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Formulary
Blue
 
   
Oestrogens for HRT (FemSeven® Sequi)
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Formulary
Blue
 
   
Progynova (HRT)
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Formulary
Blue
 
   
06.04.01.01  Sequential combined (for women with uterus)
Cyclo-Progynova (estradiol valerate 2mg + norgestrel 500mcg)
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Formulary
Blue
 
   
Elleste-Duet (estradiol 1mg+ norethisterone acetate 1mg)
View adult BNF View SPC online View childrens BNF
Formulary
Blue

Note- there are 2 preparations with different strengths of estradiol 

 
   
Elleste-Duet (estradiol 2mg + norethisterone acetate 1mg)
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Formulary
Blue

Note- there are 2 preparations with different strengths of estradiol 

 
   
Evorel Sequi  (estradiol ~50mcg/24hrs + norethisterone acetate ~170mcg/24hrs)
(patch)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
Femseven Sequi  (estradiol ~50mcg/24hrs + levonorgestrel ~10mcg/24hrs)
(patch)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
06.04.01.01  Continuous combined (for women with uterus)
Femoston (estradiol 1 mg+ dydrogesterone 10 mg)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
Femoston (estradiol 2 mg+ dydrogesterone 10 mg)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
Kliofem (estradiol 2mg + norethisterone acetate 1mg)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
Kliovance (estradiol 1mg + norethisterone acetate 500mcg)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
Evorel Conti (estradiol ~50mcg/24hrs + norethisterone acetate ~170mcg/24hrs)
View adult BNF View SPC online View childrens BNF
Formulary
Blue

Reserved for patients unable to swallow

 
   
Femseven Conti (estradiol ~50mcg/24hrs + levonorgestrel ~7mcg/24hrs)
View adult BNF View SPC online View childrens BNF
Formulary
Blue

Reserved for patients unable to swallow

 
   
06.04.01.01  Unopposed oestrogen (for women without uterus)
06.04.01.01  Topical oestrogens
Estriol 0.01% (cream)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
Estriol 0.1% (cream)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
Vagifem ( Estradiol)
(Vaginal tablet)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
06.04.01.01  Other to top
Ethinylestradiol
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
Raloxifene Hydrochloride
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
Link  NICE TA160 Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women
Link  NICE TA161-Secondary prevention of osteoporotic fragility fractures in postmenopausal women
   
Tibolone
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
06.04.01.02  Progestogens
Medroxyprogesterone Acetate (Provera®)
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
Norethisterone
View adult BNF View SPC online View childrens BNF
Formulary
Blue
 
   
06.04.02  Male sex hormones and antagonists
Testosterone undecanoate (Restandol Testocaps®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Testogel (Testosterone gel )
View adult BNF View SPC online View childrens BNF
Formulary
Green

50mg/5g gel sachet

 
   
Testosterone injection (Sustanon 250®)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Testosterone undecanoate (Nebido® injection)
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
Tostran (Testosterone gel )
View adult BNF View SPC online View childrens BNF
Formulary
Green

2% gel

 
   
06.04.02  Anti-androgens
Finasteride
View adult BNF View SPC online View childrens BNF
Formulary  
Link  NICE CG97 Lower urinary tract symptoms: quick reference guide
   
Dutasteride (Avodart®)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Consultant urologist only for following scenarios

      • Intolerant to finasteride

                         or

      • If finasteride is ineffective



 
   
Cyproterone Acetate
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
06.04.03  Anabolic steroids
06.04.04  Gender dysphoria to top
06.05  Hypothalamic and pituitary hormones and anti-oestrogens
06.05.01  Hypothalamic and anterior pituitary hormones and anti-oestrogens
Menotrophin (injection)
(endocrine)
View adult BNF View SPC online View SMC online View childrens BNF
Formulary
Red Hospital
 
   
06.05.01  Anti-oestrogens
Buserelin (fertility)
(nasal spray)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
Fertility monitoring unit only 
   
Cetrorelix (injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
Fertility monitoring unit only 
   
Choriogonadotropin (fertility)
(injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
Fertility monitoring unit only 
   
Clomifene Citrate
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

Fertility monitoring unit only 

 
Link  Fertility Monitoring - Ovulation induction using clomifene citrate/gonadotrophins
   
Cyclogest (pessaries)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
Fertility monitoring unit only 
   
Follitropin alfa (infertility)
(injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

Available as

  • 300units
  • 450units
  • 900units
 
   
Menotrophin (injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

Fertility monitoring unit only


Avaiable as

  • 600 units
  • 1200 units
 
   
Nafarelin (nasal spray)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
Fertility monitoring unit only 
   
Progynova (fertility)
(tab)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
Fertility monitoring unit only 
   
06.05.01  Anterior pituitary hormones
Choriogonadotropin Alfa (endocrine)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Chorionic Gonadotrophin (Choragon®)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Chorionic Gonadotrophin (Pregnyl®)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Follitropin Alfa  (endocrine)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Follitropin Alfa and Beta (endocrine)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Human Menopausal Gonadotrophins
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Somatropin
(Growth hormone)
View adult BNF View SPC online View childrens BNF
Formulary
High Cost Medicine

Traffic light information

Traffic light Details
Red
  • Neuroendocrine tumours
  • Prevention of complications following pancreatic surgery
Shared care
  • Treatment of growth failure in children 
  • Growth hormone replacement in adult growth hormone deficiency
 
Link  Shared care-Growth failure in children
Link  Shared care-Growth hormone replacement in adults
Link  NICE TA188: Somatropin for growth failure in children
Link  NICE TA64: Growth hormone deficiency (adults)
   
Tetracosactide (Synacthen®)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Thyrotropin Alfa
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

Restricted to oncology and endrocrinology use only

 
   
06.05.01  Hypothalmic hormones to top
Gonadorelin (injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Protirelin (Thyrotropin-releasing hormone)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

For TRH test

 
   
06.05.02  Posterior pituitary hormones and antagonists
Tolvaptan (Jinarc®)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
High Cost Medicine
BlueTeq

 

Very specialist use within Renal Services only - in strict accordance with the NICE guidance relating to the treatment of Autosomal Dominant Polycystic Kidney Disease

 
Link  NICE TA358: Autosomal dominant polycystic kidney disease - tolvaptan
   
06.05.02  Posterior pituitary hormones
 note 

PSA:Risk of severe harm or death when desmopressin is omitted or delayed in patients with cranial diabetes insipidus

Desmopressin (tablets)
View adult BNF View SPC online View childrens BNF
Formulary  
   
Desmopressin (Nasal spray-10mcg/spray)
View adult BNF View SPC online View childrens BNF
Formulary  
   
Desmopressin (injection)
View adult BNF View SPC online View childrens BNF
Formulary  
   
Desmopressin (Octim® high dose nasal spray)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Ipswich Hospital

Haematology use only

Colchester Hospital

Desmopressin (Octim) is considered non-formulary

 
   
Terlipressin (injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Vasopressin  (Argipressin)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

Hospital use only - for organ preservation and critical care use

 
   
06.05.02  Antidiuretic hormone antagonists
06.06  Drugs affecting bone metabolism
06.06  Osteoporosis to top
06.06.01  Calcitonin and parathyroid hormone
Calcitonin (salmon) / Salcatonin
(Injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

MHRA:Increased risk of cancer with long-term use

 
   
Teriparatide (injection)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red Hospital
High Cost Medicine
BlueTeq

For treatment of osteoporosis

Ipswich Hospital/IESCCG

Teriparatide is considered a hospital-only medicine ony - Hospital Rheumatology Consultant initiation only

Colchester Hospital/NEECCG

Teriparatide is available for prescribing within Primary Care under Shared Care Agreement

 
Link  NICE TA161-Secondary prevention of osteoporotic fragility fractures in postmenopausal women
   
06.06.02  Bisphosphonates and other drugs affecting bone metabolism
 note 

Joint guidance

 
06.06.02  Bisphosphonates
Alendronic Acid
(Once weekly tab)
View adult BNF View SPC online View childrens BNF
Formulary
Blue

The dispersible tablet is not approved for local use.

 
   
Risedronate
(once weekly)
View adult BNF View SPC online View childrens BNF
Formulary
Blue

Treatment has limited use in practice - it is second line treatment only utilised if patients are intolerant to alendronic acid therapy

 
   
Disodium Pamidronate
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital
 
   
Ibandronic Acid (50mg tablets)
(osteoporosis)
View adult BNF View SPC online View childrens BNF
Formulary
Green

Specialist initiation


Reduction of bone damage in bone metastases in breast cancer

 
   
Ibandronic Acid injection
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

Ipswich Hospital

Ibandronic acid injection is a formulary medicine - for postmenopausal osteoporosis for patients unable to take/intolerant to oral medicines

Colchester Hospital

Ibandronate acid injection is considered non-formulary

 
   
Sodium Clodronate
View adult BNF View SPC online View childrens BNF
Formulary
Green

Specialist initiated


Bone pain only

 
   
Zoledronic Acid (4mg injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

Note 2 different strengths of Zolendronic acid


For oncology related indications

 
   
Zoledronic Acid (5mg injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

Note 2 different strengths of Zolendronic acid


 For osteoporosis and Paget's disease

 
   
06.06.02  Denosumab
Prolia® (Denosumab )
(osteoporosis)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red Hospital

MHRA:Osteonecrosis of the external auditory canal

MHRA: Osteonecrosis of the jaw


Note two different brands

Prolia is indicated for 

  • Treatment of osteoporosis in postmenopausal women and in men at increased risk of fractures
  • Treatment of bone loss associated with hormone ablation in men with prostate cancer at increased risk of fractures

For osteoporosis-NICE TA204

Ipswich Hospital/IESCCG

Denosumab (for osteoporosis) is considered a "hospital-only" medicine

Colchester Hospital/NEECCG

Denosumab (for osteoporosis) is available for Primary Care prescribing under a Shared Care Agreement

 
Link  NICE TA204: Osteoporotic fractures - denosumab
   
XGEVA® (Denosumab )
(metastases)
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

MHRA:Osteonecrosis of the external auditory canal

MHRA: Osteonecrosis of the jaw

MHRA:Denosumab (Xgeva▼) for giant cell tumour of bone: risk of clinically significant hypercalcaemia following discontinuation

MHRA:Denosumab (Xgeva▼) for advanced malignancies involving bone: study data show new primary malignancies reported more frequently compared to zoledronate


Note two different brands

XGEVA is indicated for 

  • Prevention of skeletal related events in patients with bone metastases from solid tumours
 
Link  NICE TA265: Bone metastases from solid tumours - denosumab: guidance
Link  NICE TA549 Denosumab for preventing skeletal-related events in multiple myeloma (terminated appraisal)
   
06.06.02  Strontium renelate to top
06.07  Other endocrine drugs
06.07.01  Bromocriptine and other dopaminergic drugs
Bromocriptine
View adult BNF View SPC online View childrens BNF
Formulary
Green

Specialist initiation only

 
   
Cabergoline
View adult BNF View SPC online View childrens BNF
Formulary
Green

Specialist initiation only, unless short course to prevent lactation

 
   
Quinagolide
View adult BNF View SPC online View childrens BNF
Formulary
Green

Specialist initiation only

 
   
06.07.02  Drugs affecting gonadotrophins
Danazol
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
   
06.07.02  Gonadorelin analogues
Goserelin
View adult BNF View SPC online View childrens BNF
Formulary

Traffic light information

Traffic light Details
Red Breast cancer
Shared care Prostatic carcinoma
 
Link  Gonadorelin Analogues in Prostate Cancer- Shared Care
   
Leuprorelin
View adult BNF View SPC online View childrens BNF
Formulary
Red Hospital

First line for gynaecology e.g. endometriosis, endometrial thinning

 
   
Triptorelin (Decapeptyl SR ®)
(Non- malignant indications)
View adult BNF View SPC online View childrens BNF
Formulary

Traffic light information

Traffic light Details
Red Gynaecological indications
Shared care Prostate cancer
 
Link  Gonadorelin Analogues in Prostate Cancer- Shared Care
   
06.07.02  Breast pain (mastalgia) to top
06.07.03  Metyrapone
Metyrapone (Metopirone®)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted

Note: this treatment is very expensive and when appropriate, must only be initiated by a Consultant specialist

Ipswich Hospital

Metyrapone is considered a formulary medicine

Colchester Hospital

Metyrapone is considered a non-formulary medicine

 
   
06.07.04  Somatomedins
 ....
 Non Formulary Items
Abaloparatide

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Acarbose  (Glucobay®)

View adult BNF View SPC online View childrens BNF
Non Formulary

Very rarely used medicine - new patients unlikely to be initiated on treatment

 
Albiglutide  (Eperzan®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
Link  IHT- Therapeutic Substitution Register
 
Alogliptin / pioglitazone  (Incresync®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Armour thyroid ®

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Buserelin
(endometriosis)

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

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Cortisone Acetate
(Cortisone)

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Desmopressin  (DesmoMelt®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Desmopressin  (Desmotabs®)

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
 
Disodium Pamidronate  (Aredia® Dry Powder)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Empagliflozin + linagliptin  (Glyxambi®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Empagliflozin and Metformin  (Synjardy®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Follitropin Alfa biosimilar  (Bemfola®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Follitropin delta  (Rekovelle®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ganorelix  (Orgalutran®)

View adult BNF View SPC online View childrens BNF
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
 
Glipizide

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ibandronic acid IV infusion  (Bondronat®)

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

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

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
Non Formulary
 
Insulin bovine  (Hypurin® Bovine Neutral)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Insulin degludec with insulin aspart  (DegludecPlus)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Insulin porcine  (Hypurin® Porcine Neutral)

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

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Isophane Insulin  (Hypurin® Porcine Isophane)

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

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
 
Ketoconazole  (Ketoconazole HRA)

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
 
Lucozade ®

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mecasermin  (Increlex®)

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine

MHRA:Risk of benign and malignant neoplasia


 
Nandrolone  (Deca-Durabolin®)

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

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

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

View adult BNF View SPC online View childrens BNF
Non Formulary
High Cost Medicine
 
Pioglitazone and Metfomin  (Competact®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Potassium Iodide

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Prednisone MR
(Lodotra)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Repaglinide  (Prandin®)

View adult BNF View SPC online View childrens BNF
Non Formulary

04/03/2021: Department of Health and Social Care & NHS England and Improvement: Supply Disruption Alert for Repaglinide 1mg and 2mg tablets- out of stock until May 2021. 

  • NHS Ipswich and East Suffolk CCG: Please contact the ESNEFT IPSWICH HOSPITAL DIABETES TEAM via the Task feature on SystmOne for any diabetes-related queries including support to switch complex patients currently on repaglinide. 
  • NHS North East Essex CCG: Contact North East Essex Diabetes Service (NEEDS) via the usual routes. 
 
Saxagliptin and metformin  (Komboglyze®)

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
 
Strontium Ranelate  (Protelos®)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tolvaptan  (Samsca®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Red Hospital
High Cost Medicine

Only utilised in very specialist circumstances and under very specific prescribing criteria

Treatment is only funded by NHS England for the treatment of hyponatraemia secondary to the Syndrome of Inappropriate Antidiuretic Hormone (SIADH) in patients requiring cancer chemotherapy

Link  NICE TA358: Autosomal dominant polycystic kidney disease - tolvaptan
 
Treatment of hypoglycaemia  (Rapilose® gel)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ulipristal  (Esmya®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Red Hospital

MHRA alert: Risk of serious liver injury: new restrictions to use and requirements for liver function monitoring before, during, and after treatment

MHRA: Suspension of the licence due to risk of serious liver injury


IESCCG advise GPs not to prescribe Esmya and stop patients currently using Esmya and seek advice from a specialist where required. Any new requests for prescribing Esmya within primary care should not be accepted and referred back to the specialist due to the suspension of the product licence.

 

 
Vildagliptin

View adult BNF View SPC online View childrens BNF
Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
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

Blue

For routine prescribing in primary and secondary care.   

Green

Initiated (if clinically urgent) or advised (if non-urgent) by specialist in secondary care, prescribing can be continued in primary care.   

Amber

Shared care  

Red Hospital

Hospital only  

Double Red

There should be no prescribing of these drugs  

Mixed

The traffic light of the drug is dependant on the indication. Please see individual drug entry for details  

netFormulary