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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:
Please contact EKHUFT Medicines Information ext. 7236001 or 01233 616001 with any queries.NHS
 Details...
06.01  Drugs used in diabetes
 note  Management of adults with diabetes undergoing surgery and elective procedures: Improving standards (2011)
Glucose
(Oral)
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Formulary
Green
  • For Hypoglycaemia (Blood glucose less than 4 mmol/L). Clinical areas are expected to have supplies of emergency oral glucose preparations so as to allow the recommended minimium in adults of 15g of glucose to be administered. These may be in Hypoboxes which are being rolled out. The treatment in conscious patients is 15mls of GlucoJuice®. Those adults with partial consciousness or swallowing problems should be treated with oral mucosal application of two 10mL tubes of GlucoGel®.
  • For oral Glucose Tolerance Test usually coordinated through clinical biochemistry. See links below for protocols.
     
  • Link  Oral glucose tolerance test - protocol for children
    Link  Oral glucose tolerance test - protocol for pregnancy
       
    Insulin Degludec (Tresiba)
    (Specialist use only)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Further information on the guidelines for using this insulin can be found by accessing SharePoint > Pharmacy > Drugs & Therapeutics. 
       
    06.01.01  Insulins
     note 

    Warning  Prescribe all insulins consistant with national safety advice. See The adult patient’s passport to safer use of insulin. The Trust recommended e-learning module for safe insulin use is "The six steps to Insulin Safety"
    Warning Never administer to a dose written ambiguously. Report all scripts written with U or IU abbreviation as a clinical incident. Note that when a patient receives a tenfold or greater overdose of insulin because a prescriber abbreviates the words ‘unit’ or ‘international units’ , despite the care setting having an electronic prescribing system in place (even without harm) is regarded as an NHS Never Event.
    Warning When a health care professional fails to use a specific insulin administration device i.e. does not use an insulin syringe or insulin pen to measure insulin (even without harm) it is regarded as an NHS Never Event.

    Warning In renal impairment half-life becomes prolonged, reduction of dose may be necessary

    Safer Prescribing, Administration and Dispensing of Insulin Poster

    Adult In-Patient Guidelines for the safe and effective use of insulin in clinical areas

    06.01.01.01  Short-acting insulins
     note 

    Warning  Prescribe all insulins consistant with national safety advice. See The adult patient’s passport to safer use of insulin. The Trust recommended e-learning module for safe insulin use is "The six steps to Insulin Safety"
    Warning Never administer to a dose written ambiguously. Report all scripts written with U or IU abbreviation as a clinical incident.
     
    Safer Prescribing, Administration and Dispensing of Insulin Poster

    Adult In-Patient Guidelines for the safe and effective use of insulin in clinical areas
    70 issued in September 2015 does not specify explicitly if an insulin is short-acting

    Insulin (Actrapid®)
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    Formulary
    Green
    10ml vial
  • Ward stock as per EKHUFT Adult In-Patient Guidelines for the safe and effective use of Insulin in clinical areas
  • For short term use ONLY 
  •    
    Insulin (Humulin® S)
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    Formulary
    Green
    10 ml vial 
       
    Insulin Aspart (Fiasp )
    (3ml pre-filled pen (Flex Touch)and 3ml penfill catridges)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green

    Black triangle drug
    To be prescribed by Diabetic specialists only

     
       
    Insulin Aspart  (NovoRapid®)
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    Formulary
    Green
    3ml penfill, 3ml flexpen, 10 ml vial
  • 10 ml vial is ward stock as per EKHUFT Adult In-Patient Guidelines for the safe and effective use of Insulin in clinical areas 
  •    
    Insulin bovine (Hypurin® Bovine Neutral)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    10ml vial
  • To be initiated on specialist advice


     
  •    
    Insulin Glulisine (Apidra®)
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    Formulary
    Green
    10ml vial

     
       
    Insulin Lispro (Humalog®)
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    Formulary
    Green

    (Biosimilars may be Black triangle drug)

    3ml cartridge, 10ml vial

    Restricted Item  New high strength formulation available: Humalog 200units/ml

    Restricted as per EKPG guidance to initiation by consultants, diabetes nurses and GPs with special interests.
    For use where

    • the dose of U100 insulin requires a large volume to be injected which is causing pain at the injection site.
    • the dose of insulin exceeds the maximum deliverable by one administration of the available injection device (most pen injectors deliver a maximum of 60 to 80 units)
     
       
    Insulin porcine  (Hypurin® Porcine Neutral)
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    Restricted Drug Restricted 10ml vial
  • Use for patients who cannot tolerate human actrapid
  • To be initiated on specialist advice

     
  •    
    06.01.01.01  Soluble Insulin
    06.01.01.01  Rapid Acting Insulin Analogues to top
    06.01.01.02  Intermediate- and long-acting insulins
     note 

    Warning  Prescribe all insulins consistant with national safety advice. See The adult patient’s passport to safer use of insulin. The Trust recommended e-learning module for safe insulin use is "The six steps to Insulin Safety"
    Warning Never administer to a dose written ambiguously. Report all scripts written with U or IU abbreviation as a clinical incident.

    Safer Prescribing, Administration and Dispensing of Insulin Poster

    Adult In-Patient Guidelines for the safe and effective use of insulin in clinical areas

    Insulin Glargine (Abasaglar®)
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    First Choice
    Green
    Biosimilar of insulin glargine (Lantus)
    Abasaglar is recommended as the first choice insulin for new type 2 diabetic patients requiring a long acting insulin analogue in accordance with NICE criteria. 

    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
     
       
    Insulin degludec (Tresiba®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Specialist use only.

    Please refer to SharePoint > Pharmacy > Drugs & Therapeutics for full guidance on the use of Insulin Degludec.
     
       
    Insulin Detemir (Levemir®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    3mL cartridge, 3mL prefilled pen
  • Use as per NICE guidance  
  • Link  NICE Guidance on type 1 & 2 diabetes management (inc. long acting insulin)
       
    Insulin Glargine (Lantus®)
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    Formulary
    Green
    3mL cartridge for ClikSTAR (OptiPen no longer supplied Dec 2011)
    3mL disposable prefilled pen - Solostar® (OptiSet® phased out by Dec 2011)
    10mL vial

  • Restricted for patients as per NICE guidance
  • 10 ml vial is ward stock as per EKHUFT Adult In-Patient Guidelines for the safe and effective use of Insulin in clinical areas 
  • Link  Diabetes UK: Sanofi-aventis discontinues OptiSet, OptiClick & OptiPen Pro I
    Link  MTRAC: Review of evidence surrounding increased cancer risk with glargine, 2010
    Link  NICE Guidance on management of type1 and type 2 diabetes
       
    Insulin Glargine (Toujeo Doublestar)
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    Restricted Drug Restricted
    Amber

    To be prescribed by Diabetes specialists only.

    This is to be considered for patients requiring higher volumes of Toujeo device. Ensure that the device prescribed is the same as what the patient is used to using and has been trained in using the device.

     
       
    Insulin glargine (Toujeo®)
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    Restricted Drug Restricted
    Amber
    Approved for initiation by diabetes specialists only.
    Toujeo is not bio equivalent so a dose adjustment is required when switching from Lantus or any other basal insulin to Toujeo. It is restricted to patients requiring doses of insulin which exceed the end of their current delivery device (typically 60 to 80 units per day). Patients who experience difficulty with injections at doses greater than 40 units per day may also be considered for Toujeo on an individual patient basis. 
    Link  Insulin Toujeo (insulin glargine) 300 units per ml
    Link  Insulin Toujeo EKPG guidance
       
    Insulin Zinc suspension (Hypurin®Bovine Lente)
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    Restricted Drug Restricted
    Green
    10ml vial
  • To be initiated on specialist advice

     
  •    
    Isophane Insulin (Humulin® I)
    View adult BNF View SPC online View childrens BNF
    Formulary 3mL cartridge
    3mL prefilled pen- Older prefilled pen discontinued March 2011 KwikPen still available)
    10mL vial 
       
    Isophane Insulin (Hypurin® Bovine Isophane)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    10ml vial
  • To be initiated on specialist advice

     
  •    
    Isophane Insulin (Insulatard®)
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    Formulary
    Green
    3ml penfil, 10ml vial 
       
    Isophane Insulin (Insuman® Basal)
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    Formulary
    Green
     
       
    Protamine Zinc Insulin (Hypurin® Bovine Protamine Zinc)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted 10ml vial
  • To be initiated on specialist advice

     
  •    
    06.01.01.02  Biphasic insulins
    Biphasic Insulin Aspart (NovoMix® 30)
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    Formulary
    Green
    3ml cartridge,3 ml flexpen 
       
    Biphasic Insulin Lispro (Humalog® Mix)
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    Formulary
    Green
    Available as Mix 25 and 50
    3mL cartridge, 3mL prefilled pen (KwikPen)
     
       
    Biphasic Isophane Insulin (Humulin® M3)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    3mL cartridge, 3mL prefilled pen KwikPen®, 10mL vial
  • 10 ml vial is ward stock as per EKHUFT Adult In-Patient Guidelines for the safe and effective use of Insulin in clinical areas  
  •    
    Biphasic Isophane Insulin (Hypurin® Porcine 30/70 Mix)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    3ml cartridge, 10ml vial 
       
    06.01.01.02  Intermediate Acting Insulin
    06.01.01.02  Long Acting Insulin Analogues
    06.01.01.03  Hypodermic equipment to top
    Accu-Check Aviva Test Strips ((Accu-Check Aviva Test Strips))
    (Box of 50 test strips)
    View adult BNF View SPC online View childrens BNF
    Formulary

    For use in paediatrics only

     
       
    Fastclix Lancets ((Accu-check Aviva Fastclix Lancets))
    (Box of 204)
    View adult BNF View SPC online View childrens BNF
    Formulary

    For use in paediatrics only

     
       
    06.01.02  Antidiabetic drugs
     note  Management of adults with diabetes undergoing surgery and elective procedures: Improving standards (2011)
    06.01.02.01  Sulphonyureas
     note  Warning Beware hypoglycaemia in mild to moderate renal impairment; avoid where possible in severe renal impairment
    STOPP v2 recommendation Sulphonylureas with a long duration of action (e.g. glibenclamide, chlorpropamide, glimepiride) inappropriate to use in patients aged 65 years and older with type 2 diabetes mellitus (risk of prolonged hypoglycaemia).
    Gliclazide
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    Formulary
    Green
    Tablets 
       
    Gliclazide (Diamicron®MR)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Grey
    Tablets MR
  • Gliclazide modified release 30 mg may be considered to be approximately equivalent in therapeutic effect to standard formulation gliclazide 80 mg
    As of November 2014 determined to be a drug of low priority by East Kent CCGs. These are medicines for which there are safer and more cost effective alternatives.


     
  •    
    Glimepiride
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    Restricted Drug Restricted
    Grey

    Tablets

     

    • Restricted to consultant ONLY
      Warning Stop if eGFR < 30 mL/min/1.73 m2
      STOPP v2 recommendation Sulphonylureas with a long duration of action (e.g. glibenclamide, chlorpropamide, glimepiride) inappropriate to use in patients aged 65 years and older with type 2 diabetes mellitus (risk of prolonged hypoglycaemia).
     
       
    Glipizide
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    Formulary
    Green
    Tablets 
       
    Tolbutamide
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    Restricted Drug Restricted
    Green
    Tablets
  • Renal impairment ONLY 
  •    
    06.01.02.02  Biguanides
    Metformin
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    First Choice
    Green
    Tablets
  • Use within license unrestricted
  • Restricted Item Out of license use restricted to initiation by consultant gynaecologist/endocrinologist in polycystic ovary syndromeNHS evidence
  • note The recommendation of the Trust diabetiologists (different from SPC) are:
    1. Review dose if Creatinine>130umol/L or eGFR < 45 mL/min/1.73 m2
    2. Warning Stop if Creatine>150 umol/L or eGFR < 30 mL/min/1.73 m2
    3. Warning Caution in those at risk of AKI or borderline renal function






    STOPP v2 recommendation Metformin inappropriate to use in patients aged 65 years and older if eGFR < 30 ml/min/1.73m2 (risk of lactic acidosis).
     
  • Metformin Hydrochloride MR
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Tablets
  • Restricted to patients with Gastrointestinal side effects with standard tablets
  • note The recommendation of the Trust diabetiologists (different from SPC) are:
    1. Review dose if Creatinine>130umol/L or eGFR < 45 mL/min/1.73 m2
    2. Warning Stop if Creatine>150 umol/L or eGFR < 30 mL/min/1.73 m2
    3. Warning Caution in those at risk of AKI or borderline renal function






    STOPP v2 recommendation Metformin inappropriate to use in patients aged 65 years and older if eGFR < 30 ml/min/1.73m2 (risk of lactic acidosis).

     
  •    
    06.01.02.03  Other antidiabetic drugs
    Acarbose (Glucobay®)
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    Restricted Drug Restricted
    Green
    Tablets
  • Consider acarbose for a person unable to use other oral glucose-lowering medications. (NICE CG87) 
  •    
    Alogliptin (Vipidia®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    As of June 2014 the cheapest gliptin. 
    Link  East Kent Prescribing Group Alogliptin
    Link  NICE ESNM20 Type 2 diabetes: alogliptin
       
    Canagliflozin (Invokana®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
  • Use only as per East Kent Prescribing Group Guidelines and relevant NICE Technical Appraisals 3 months after their publication date.
    Warning
    • Risk normoglycaemic diabetic ketoacidosis. Interrupt treatment with the SGLT2 inhibitor in patients who are hospitalised for major surgery or acute serious illnesses; treatment may be restarted once the patient’s condition has stabilised
    • Risk osteoporosis
    • Increased risk of significant peripheral vascular disease complications


     
  • Link  NICE TA315 Canagliflozin in combination therapy for treating type 2 diabetes
    Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
       
    Dapagliflozin (Forxiga®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Tablets
  • Use only as per East Kent Prescribing Group Guidelines and relevant NICE Technical Appraisals 3 months after their publication date.
    Warning
    • Risk normoglycaemic diabetic ketoacidosis. Interrupt treatment with the SGLT2 inhibitor in patients who are hospitalised for major surgery or acute serious illnesses; treatment may be restarted once the patient’s condition has stabilised
    • Risk osteoporosis
    • Unknown at this time if increased risk of significant peripheral vascular disease complications

    Warning STOP if eGFR < 60 mL/min/1.73 m2
     
  • Link  Dapaglaflozin with insulin for treating type 1 diabetes
    Link  NICE TA 597 Dapagliflozin with insulin for treating type 1 diabetes
    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
       
    Empagliflozin (Jardiance®)
    View adult BNF View SPC online View childrens BNF
    Formulary
  • Use only as per East Kent Prescribing Group Guidelines and relevant NICE Technical Appraisals 3 months after their publication date.
    Warning
    • Risk normoglycaemic diabetic ketoacidosis. Interrupt treatment with the SGLT2 inhibitor in patients who are hospitalised for major surgery or acute serious illnesses; treatment may be restarted once the patient’s condition has stabilised
    • Unknown at this time if increased risk osteoporosis
    • Unknown at this time if increased risk of significant peripheral vascular disease complications

     
  • Link  NICE TA 336: Empagliflozin in combination therapy for treating type 2 diabetes
    Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
       
    Exenatide (Bydureon®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Injection
  • Kent & Medway Shared Care
  • Diabetologist
  • Once weekly formulation
  • Effect of Bydureon® may persist for 10 weeks after discontinuation
    WarningThe recommendation of the Trust diabetiologists is with Modified/once weekly (2mg) – STOP if eGFR <50mL/min/1.73 m2
     
  • Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
       
    Exenatide (Byetta®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Injection
  • Diabetologist
  • Twice daily formulation
    The recommendation of the Trust diabetiologists is with standard release:
    WarningCaution if eGFR 30-50mL/min/1.73 m2
    WarningSTOP if eGFR < 30mL/min/1.73 m2
     
  • Link  MRHA warning on risk of acute pancreatitis and renal failure (2009)
    Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
       
    Linagliptin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Tablets
  • as per East Kent Prescribing Group Guidelines
  • For renal impairment ONLY


     
  •    
    Liraglutide (Victoza®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Injection as 6mg/ml prefilled pen
  • Diabetologists
    WarningThe recommendation of the Trust diabetiologists is STOP if eGFR < 60mL/min/1.73 m2 
  • Link  NICE TA203: Diabetes (type 2) - liraglutide
    Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
       
    Lixisenatide (Lyxumia®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Injection
    • Diabetologist
    • First line GLP-1 mimetic. Use within NICE guidance as per other GLP-1 mimetics
    NICE ESNM NICE ESNM26 Type 2 diabetes: lixisenatide Sept 2013 
    Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
    Link  NICE CG 87 Type 2 diabetes- The management of type 2 diabetes
       
    Pioglitazone (Actos®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Tablets
  • as per East Kent Prescribing Group Guidelines
    WarningRisk of exacerbating heart failure in renal impairment





    STOPP v2 recommendation Thiazolidenediones (e.g. rosiglitazone, pioglitazone) inappropriate to use in patients aged 65 years and older with heart failure (risk of exacerbation of heart failure).
     
  • Link  Risk of bladder cancer: MHRA safety update
    Link  Risk of cardiac failure when combined with insulin (MHRA safety update Jan 2011)
       
    Repaglinide (Prandin®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Tablets
  • Consider offering a rapid-acting insulin secretagogue to a person with an erratic lifestyle.
    WarningThe recommendation of the Trust diabetiologists is use with caution in renal impairment 
  •    
    Sitagliptin (Januvia®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Tablets
  • as per East Kent Prescribing Group Guidelines
    WarningReduce dose to 50mg OD if eGFR 30-50 mL/min/1.73 m2
    WarningReduce dose to 25mg OD if eGFR < 30mL/min/1.73 m2
     
  • Link  Risk of acute pancreatitis:MHRA update Sept 12
       
    06.01.02.03  DPP-4 inhibitors to top
    06.01.02.03  GLP-1 mimetics
    semaglutide (Ozempic)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
       
    06.01.02.03  SGLT2 inhibitors
    Ertugliflozin (Steglatro®)
    (5mg and 15mg tablets available)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    NICE TA Guidance (TA572) recommends ertugliflozin as monotherapy or with metformin for treating type 2 diabetes in adults.

    Warning

     
    Link  Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes
       
    06.01.02.05  Glucagon-like peptide-1 receptor agonists - once weekly
    dulaglutide (Trulicity®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
     
    Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
       
    06.01.02.07  Other antidiabetic drugs
    06.01.03  Diabetic ketoacidosis to top
    06.01.04  Treatment of hypoglycaemia
    Glucagon (GlucaGen® HypoKit)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Injection 
       
    GlucoGel®
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    For Hypoglycaemia (Blood glucose less than 4 mmol/L). Clinical areas are expected to have supplies of emergency oral glucose preparations so as to allow the recommended minimium in adults of 15g of glucose to be administered. These may be in Hypoboxes which are being rolled out. The treatment in conscious patients is 15g of GlucoJuice® contained in 60ml. Those adults with partial consciousness or swallowing problems should be treated with oral mucosal application of two 10mL tubes of GlucoGel®
       
    GlucoJuice®
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    For Hypoglycaemia (Blood glucose less than 4 mmol/L). Clinical areas are expected to have supplies of emergency oral glucose preparations so as to allow the recommended minimium in adults of 15g of glucose to be administered. These may be in Hypoboxes which are being rolled out. The treatment in conscious patients is 15g of GlucoJuice® contained in 60ml. Those adults with partial consciousness or swallowing problems should be treated with oral mucosal application of two 10mL tubes of GlucoGel®
       
    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
    06.01.06  Diagnostic and monitoring agents for diabetes mellitus
    Blood Ketone Testing Strips (Optium Neo)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    • According to NICE TA NG18
    • Separate meter must be provided for blood ketone testing
     
       
    06.01.06  Blood glucose monitoring
    06.01.06  Urinalysis
    06.01.06  Oral glucose tolerance test
    06.02  Thyroid and Antithyroid drugs to top
    06.02.01  Thyroid hormones
    Levothyroxine
    View adult BNF View SPC online View childrens BNF
    First Choice
    Green
    Tablets 
    Liothyronine Sodium
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber

    Injection, Tablets

    Consultant Endocrinologist or psychiatrist initiation only. All oral NHS use must be consistent with the RMOC guidance.

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

     
    Link  Guidance on liothyronine prescribing
    Link  RMOC Guidance – Prescribing of Liothyronine 9th November 2018
       
    06.02.02  Antithyroid drugs
    Carbimazole (Neo-Mercazole®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.  
    Link  CSM Warning: Neutropenia and agranulocytosis
       
    Propylthiouracil
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    Tablets
  • Endocrinologists

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.  
  •    
    06.03  Corticosteroids
     note 

    Remember that on patients on maintenance/long term therapy ommission can present with an adrenal crisis (management of this is at Society for Endocrinology guidelines). The sick day rules are:

    1. double daily oral glucocorticoid dose during intercurrent illness with fever that requires bed rest and/or antibiotics
    2. administer glucocorticoids per i.v. or i.m. injection or iv infusion during prolonged vomiting or diarrhoea, during preparation for colonoscopy or in case of acute trauma or surgery requiring general anaesthesia

    There are more detailed EKHUFT guidelines accessible via Microguide -> Switch Guide -> General Medicine -> Endocrinology

    STOPP v2 recommendation Corticosteroids inappropriate to use in patients aged 65 years and older:
    • long-term (>3 months) as monotherapy for rheumatoid arthrtitis (risk of systemic corticosteroid side-effects)
    • (other than periodic intra-articular injections for mono-articular pain) for osteoarthritis (risk of systemic corticosteroid side-effects)
    • with concurrent NSAID without PPI prophylaxis (increased risk of peptic ulcer disease)
    06.03.01  Replacement therapy
     note 

    Remember that on patients on maintenance/long term therapy ommission can present with an adrenal crisis (management of this is at Society for Endocrinology guidelines). The sick day rules are:

    1. double daily oral glucocorticoid dose during intercurrent illness with fever that requires bed rest and/or antibiotics
    2. administer glucocorticoids per i.v. or i.m. injection or iv infusion during prolonged vomiting or diarrhoea, during preparation for colonoscopy or in case of acute trauma or surgery requiring general anaesthesia

    There are more detailed EKHUFT guidelines accessible via Microguide -> Switch Guide -> General Medicine -> Endocrinology

     

    Fludrocortisone Acetate (Florinef®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets 
       
    06.03.02  Glucocorticoid therapy to top
     note 

    WarningRemember that on patients on maintenance/long term therapy ommission can present with an adrenal crisis (management of this is at Society for Endocrinology guidelines). The sick day rules are:

    1. double daily oral glucocorticoid dose during intercurrent illness with fever that requires bed rest and/or antibiotics
    2. administer glucocorticoids per i.v. or i.m. injection or iv infusion during prolonged vomiting or diarrhoea, during preparation for colonoscopy or in case of acute trauma or surgery requiring general anaesthesia

    There are more detailed EKHUFT guidelines accessible via Microguide -> Switch Guide -> General Medicine -> Endocrinology

     

    STOPP v2 recommendation Corticosteroids inappropriate to use in patients aged 65 years and older:
    • long-term (>3 months) as monotherapy for rheumatoid arthrtitis (risk of systemic corticosteroid side-effects)
    • (other than periodic intra-articular injections for mono-articular pain) for osteoarthritis (risk of systemic corticosteroid side-effects)
    • with concurrent NSAID without PPI prophylaxis (increased risk of peptic ulcer disease)


    Warning Please assess for risk of diabetes and if high risk or have impaired glucose tolerance or diabetes ensure monitoring consistent with national guidelines in place.

    Betamethasone (Betnesol®)
    View adult BNF View SPC online View childrens BNF
    Formulary Injection, Soluble tablets

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

    Warning Please assess for risk of diabetes and if high risk or have impaired glucose tolerance or diabetes ensure monitoring consistent with national guidelines in place. 
       
    Dexamethasone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Injection, Oral solution, Tablets

    Approved for use in severe or critical COVID-19 treatment in non pregnant or non breastfeeding adult patients at a dose of 6mg daily for up to 10 days - see Dexamethasone and Remdesivir in COVID19 or  FAQs on Prescribing.

     
       
    Hydrocortisone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets
  • Use for replacement therapy

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

    Warning Please assess for risk of diabetes and if high risk or have impaired glucose tolerance or diabetes ensure monitoring consistent with national guidelines in place. (especially if used in non replacement indications) 
  •    
    Hydrocortisone sodium phosphate (Efcortesol®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Injection

    Approved for use in severe or critical COVID-19 treatment in adult inpatients requiring oxygen (if dexamethasone iv not appropriate) at dose of 50mg 8 hourly daily for 7- 10 days - see  FAQs on Prescribing.

    Note that different dosing in  pregnant women (80mg bd) in RECOVERY trial - see FAQs on Prescribing.

     
    Link  UKMI Q&A: What is the equivalent dose of oral prednisolone to intravenous (IV) hydrocortisone?
       
    Hydrocortisone sodium succinate (Solu-Cortef®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red

    Injection

    • Injection salt usually used
    • Approved for use in severe or critical COVID-19 treatment in adult inpatients requiring oxygen (if dexamethasone iv not appropriate) at dose of 50mg 8 hourly daily for 7- 10 days - see  FAQs on Prescribing.

      Note that different dosing in  pregnant women (80mg bd) in RECOVERY trial - see FAQs on Prescribing.


      Warning Please assess for risk of diabetes and if high risk or have impaired glucose tolerance or diabetes ensure monitoring consistent with national guidelines in place.
     
       
    Methylprednisolone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Tablets, IM Depot injection - Depo-Medrone®,IV injection - Solu-Medrone®

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

    Warning Please assess for risk of diabetes and if high risk or have impaired glucose tolerance or diabetes ensure monitoring consistent with national guidelines in place. 
    Link  Cochrane: Oral versus Intravenous Steroids for Treatment of Relapses in Multiple Sclerosis
    Link  NICE CG8: Multiple Sclerosis; management in primary and secondary care.
       
    Prednisolone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Tablets

     

    Not approved for use as specific COVID-19 treatment except in pregnant women in RECOVERY trial - see FAQs on Prescribing  for dosing regime (40mg od) in RECOVERY trial.

    • Standard tablets can be crushed and dispersed in water for administration to patients with swallowing difficulties or NG tubes.
    • Enteric coated tablets are not as cost effective as plain tablets without strong evidence of their Gastrointestinal benefits

      Liquid
    • for use in children who cannot swallow standard tablets

      Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

      Warning Please assess for risk of diabetes and if high risk or have impaired glucose tolerance or diabetes ensure monitoring consistent with national guidelines in place.
     
    Link  UKMI Q&A: Is there any evidence to support the use of enteric coated (EC) over uncoated prednisolone tablets?
       
    Triamcinolone (Kenalog®)
    View adult BNF View SPC online View childrens BNF
    Formulary Injection

    Warning Please assess for risk of diabetes and if high risk or have impaired glucose tolerance or diabetes ensure monitoring consistent with national guidelines in place. 
       
    06.03.02  Disadvantages of corticosteroids
    06.03.02  Use of corticosteroids
     note 


    Warning Please assess for risk of diabetes and if high risk or have impaired glucose tolerance or diabetes ensure monitoring consistent with national guidelines in place.

    WarningRemember that on patients on maintenance/long term therapy ommission can present with an adrenal crisis (management of this is at Society for Endocrinology guidelines). The sick day rules are:

    1. double daily oral glucocorticoid dose during intercurrent illness with fever that requires bed rest and/or antibiotics
    2. administer glucocorticoids per i.v. or i.m. injection or iv infusion during prolonged vomiting or diarrhoea, during preparation for colonoscopy or in case of acute trauma or surgery requiring general anaesthesia

    There are more detailed EKHUFT guidelines accessible via Microguide -> Switch Guide -> General Medicine -> Endocrinology

    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 HRT
     note 

    This section is still being updated

    STOPP v2 recommendation Oestrogens inappropriate to use in patients aged 65 years and older:
  • with a history of breast cancer or venous thromboembolism (increased risk of recurrence)
  • without progestogen in patients with intact uterus (risk of endometrial cancer)
  • Combined continuous HRT patch (Evorel® Conti)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Patch 
       
    Combined continuous HRT tablet ( Kliovance, Premique)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets 
       
    Combined cyclical HRT tablet (Prempak-C)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets 
       
    Oestrogen only HRT gel (Oestrogel)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Gel 
       
    Oestrogen only HRT implant (Estradiol)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Estradiol Implants
  • Discontinued July 2011
  • Only unlicensed now products available 
  •    
    Oestrogen only HRT tablet (Elleste-Solo, Premarin)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Elleste-Solo®- Tablets
    Premarin®- Conjugated oestrogens tablet
     
       
    Oestrogens for HRT (Elleste-Solo® MX)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Patches 
       
    Oestrogens for HRT (Menorin® 50)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green
    • Gynaecology 
       
    Oestrogens for HRT (Nuvelle®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets 
       
    Tibolone (Livial®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Green

    Tablets : Not approved for use as specific COVID-19 treatment - see FAQs on Prescribing.

     
       
    06.04.01.01  Hormone replacement therapy
    06.04.01.01  Ethinylestradiol to top
    Ethinylestradiol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber

    Tablets Black triangle drug

    • 2 microgm tablets are unlicensed
      STOPP v2 recommendation Oestrogens inappropriate to use in patients aged 65 years and older:
      • with a history of breast cancer or venous thromboembolism (increased risk of recurrence)

      • without progestogen in patients with intact uterus (risk of endometrial cancer)
     
       
    06.04.01.01  Raloxifene
    Raloxifene Hydrochloride (Evista®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Brown
    Tablets
  • Limited use 
  •    
    06.04.01.02  Progestogens and progesterone receptor modulators
    Medroxyprogesterone Acetate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets 
       
    Norethisterone
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets  
       
    Progesterone (Cyclogest®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Pessary 
       
    06.04.02  Male sex hormones and antagonists
     note 
    STOPP v2 recommendation Androgens (male sex hormones) inappropriate to use in patients aged 65 years and older in the absence of primary or secondary hypogonadism (risk of androgen toxicity; no proven benefit outside of the hypogonadism indication, increased risk stroke and myocardial infarction).
    Mesterolone (Pro-Viron®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber
    Tablets
  • Endocrinology 
  •    
    Testosterone and Esters
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber
    Capsules, Injection, Patch
  • Testosterone undecanoate (oily) injection & capsule
  • Testosterone 300 microgm patch - currently unavailable
  • Endocrinology 
  •    
    Testosterone and Esters (Testogel®)
    (1% gel)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber

    For the use of Consultant Endocrinologists only

     
       
    Testosterone Gel 2% (Tostran)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber

    For the use of Consultant Endocrinologists only

     
       
    Testosterone injection (Sustanon 250®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 1
    Paediatric use as per shared care guideline 
    Link  East Kent Paediatric Use Shared care guidelines
       
    Testosterone implant
    View adult BNF View SPC online View childrens BNF
    Unlicensed Drug Unlicensed
    Amber
    Implant
     
       
    06.04.02  Anti-androgens
    Cyproterone Acetate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Tablets

     

    WarningSee MHRA warning on how to minimise risk menigioma

     
       
    Finasteride
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets
    WarningSee MHRA warning on depression risk 
    Link  NICE CG97: Lower urinary tract symptoms: quick reference guide
       
    06.04.02  Dutasteride and finasteride to top
    06.04.03  Anabolic steroids
    06.05  Hypothalamic and pituitary hormones and anti-oestrogens
    06.05.01  Hypothalamic and anterior pituitary hormones and anti-oestrogens
    06.05.01  Anti-oestrogens
    Clomifene Citrate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 1
    Tablets
  • The CSM has recommended that "clomifene" should not normally be used for longer than 6 cycles (possibly increased risk of ovarian cancer) 
  •    
    06.05.01  Anterior pituitary hormones to top
    Somatropin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber 2
    CCG
    BlueTeq

    Injection - Genotropin, Norditropin

    • Endocrinology Specialist use only
    • PBR excluded drug via MM1
    • Shared Care

      Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)

    Growth Failure/Hormone deficiency

    • MM1 form to be completed by consultant.
    • Children: Trust invoices the CCG until the patient is stabilised for Shared Care as per guidelines.
    • Adults: First 9 months of treatment may be provided by secondary care. Trust invoices the CCG for first 9 months of treatment, provided the blue-teq form has been sent to the CCGH on initiation. If continuation is clinically indicated then Shared Care should be initiated
     
    Link  NICE TA188: Human growth hormone (somatropin) for the treatment of growth failure in children (review)
    Link  NICE: Growth hormone deficiency (adults) - human growth hormone OVERVIEW AND MANAGEMENT
       
    Tetracosactide (Synacthen®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Injection, Depot injection

  • Available in two types: 250mcg (IM/IV) for short synacthen test and 1mg I.M. depot for prolonged synacthen test
  • Order using patient centre test code STD SYNC
  • Send both samples together to the laboratory with the request form for a short synacthen test
  • Please contact the Duty Biochemist (ext 86287)with any queries

  • Unlicensed use: Can be used for Infantile Spasm: by Intramuscular injection using DEPOT INJECTION: Child 1 month-2 years: Initially 500 micrograms on alternate days, adjusted according to response. 
  •    
    Thyrotropin Alfa (Thyrogen®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection

  • For specialist use
     
  •    
    06.05.01  Gonadotrophins
    06.05.01  Growth Hormone
    06.05.01  Growth hormone receptor antagonists
    06.05.01  Thyrotropin
    06.05.01  Hypothalmic hormones to top
    Protirelin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection

  • Unlicensed Drug Unlicensed
  • Specialist use only for diagnostic purposes
  • Long term manufacturing problem, currently sourcing unlicensed product from Europe. Please note strength change, now receiving 200mcg/ml. 
  •    
    06.05.02  Posterior pituitary hormones and antagonists
    06.05.02  Posterior pituitary hormones
    Desmopressin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green

    Not NHSvasopressin-sensitive cranial diabetes insipidus or in the treatment of post-hypophysectomy polyuria/polydipsia

    Different brands available.



    DDAVP: Injection 4microgm/ml, Nasal spray, Tablets
    Desmotabs: Tablets
    DesmoMelts: Oral lyophilisates
    Octim: Injection 15mcg/ml
    Not NHS Not for NHS initiation for urinary incontinence  in East Kent
    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.

     
       
    Terlipressin (Glypressin®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection

  • For specialist use ONLY

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.  
  •    
    Vasopressin (Pitressin®)
    (Argipressin)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Injection
  • Unlicensed product
  • Named Patient Only
  • For specialist use ONLY

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.  
  •    
    06.05.02  Antidiuretic hormone antagonists
    Tolvaptan (Samsca®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    High Cost Medicine
    CCG
    BlueTeq

    Black triangle drug

    Tablets
    NHS NHS availability depend upon indication. The only routinely commissioned NHS indicatios are use according to

     
    Link  TA358 Tolvaptan for treating autosomal dominant polycystic kidney disease
       
    06.06  Drugs affecting bone metabolism
    06.06  Osteoporosis to top
    06.06.01  Calcitonin and parathyroid hormone
    Calcitonin (salmon) / Salcatonin
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Injection 
       
    Teraparatide (Terrosa)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red

    Conditions to prescribe are the same as Forsteo brand

     
       
    Teriparatide (Forsteo®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    CCG
    BlueTeq

    Injection

    • Osteoporosis specialist use only.
    • As per Kent & Medway Guidance ONLY
    • PBR excluded drug via MM1
    • Usually supplied via homecare, usually Healthcare at Home

      Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)
    • Following review, teriparatide is approved for 18 months treatment only.
     
    Link  K&MAPC: Teriparatide and parathyroid hormone in severe osteoporosis
    Link  NICE : Osteoporosis overview prevention, diagnosis & management
       
    Teriparatide (Terrosa)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    CCG
    BlueTeq

    This brand is to be supplied under the same guidance as the Forsteo Brand

     
       
    06.06.02  Bisphosphonates and other drugs affecting bone metabolism
    06.06.02  Bisphosphonates
     note 
    STOPP v2 recommendation Oral bisphosphonates inappropriate to use in patients aged 65 years and older with a current or recent history of upper gastrointestinal disease i.e. dysphagia, oesophagitis, gastritis, duodenitis, or peptic ulcer disease, or upper gastrointestinal bleeding (risk of relapse/exacerbation of oesophagitis, oesophageal ulcer, oesophageal stricture)
    Alendronic Acid (Once weekly)
    View adult BNF View SPC online View childrens BNF
    First Choice
    Green
    Tablets
    Effervescent tablets available for patients with swallowing difficulties 
    Disodium Pamidronate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Red
    Infusion

  • Hypercalcaemia 
  •    
    Ibandronic Acid
    (Oncology)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Tablet (50 mg daily)

    As of November 2014 determined to be a drug of low priority by East Kent CCGs. These are medicines for which there are safer and more cost effective alternatives.
     
       
    Ibandronic Acid
    (Osteoporosis)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Tablet (150mg monthly)
    As of November 2014 determined to be a drug of low priority by East Kent CCGs. These are medicines for which there are safer and more cost effective alternatives.
     
       
    Risedronate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Tablets

  • Osteoporosis - 35mg weekly (5mg daily more costly) 
  •    
    Risedronate
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Tablets

  • Paget's disease - 30mg daily
     
  •    
    Sodium Clodronate
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber
    Bonefos: Capsules, Tablets
  • Restricted to Haematologists 
  •    
    Zoledronic Acid (Aclasta® or generic)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Infusion 5mg diluted in 100ml normal saline for administration
  • Osteoporosis specialist use only
  • Use as per guidelines. During times of shortage the Trust has authorised use of the oncology licensed preparation at osteoporosis treatment dosage.
  • Funded as part of the admission tariff
    Warning  Use based on creatinine clearance using actual body weight and the Cockcroft-Gault formula (Calculator
  •    
    Zoledronic Acid (Zometa®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Infusion 4mg diluted for administration in 100ml normal saline
  • Oncology / Haematology use  
  •    
    06.06.02  Denosumab
    Denosumab (metastases) (Xgeva®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection
  • NICE TA recommended option instead of bisphosphonates for preventing skeletal-related events caused by bone metastases from solid tumour
  • NOT Recommended for bone metastases from prostate cancer
  • Initiation must be consistent with the MHRA Safety Alert and commissioned patient access scheme to be utilised as per NICE TA265
  • Do not confuse with preparation used for osteoporosis 
  • Link  NICE TA265: Bone metastases from solid tumour
       
    Denosumab (osteoporosis)  (Prolia®)
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Red
    Injection
  • Osteoporosis specialist only initiation consistent with TA204 and the MHRA Safety Alert
  • An interim arrangement exists for both initiation and continuation of therapy in secondary care in East Kent. Primary care may have agreed to take over repeat prescribing in some other Kent and Medway CCGs and English CCGs. Please contact individual GPs if not East Kent cluster GP. See Kent and Medway Shared Care Guidelines
  • Do not confuse with alternative preparation used in cancer involving bone 
  • Link  Denosumab 60mg (Prolia): increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment
    Link  NICE : Osteoporotic Overview
       
    06.06.02  Strontium ranelate to top
     note 
    06.07  Other endocrine drugs
    06.07.01  Bromocriptine and other dopaminergic drugs
    Bromocriptine
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber

    Tablets : - Not approved for use as specific COVID-19 treatment - see FAQs on Prescribing.

    • Specialist use
     
       
    Cabergoline
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber
    Tablets

  • Specialist use 
  •    
    Quinagolide (Norprolac®)
    View adult BNF View SPC online View childrens BNF
    Formulary Tablets

    Restricted Item Only to be initiated by endocrinologist 
       
    06.07.02  Drugs affecting gonadotrophins
    Danazol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Capsules 
       
    06.07.02  Gonadorelin analogues
    Goserelin
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted
    Amber
    Implant
     
       
    Leuprorelin Acetate
    View adult BNF View SPC online View childrens BNF
    Restricted Drug Restricted Injection
  • Only 3.75mg strength on formulary as uniquely licensed prior to intrauterine procedures 
  •    
    Triptorelin (Decapeptyl SR®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber
    Injection

    First choice in Prostate cancer see section 08.03.04.02

     
       
    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
    Amber
    Capsules
  • Endocrinologist

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.  
  •    
    06.07.04  Somatomedins
     ....
     Non Formulary Items
    Alendronic Acid with colecalciferol  (Fosavance®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Betamethasone  (Betnelan®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
     
    Biphasic Isophane Insulin  (Insuman® Comb)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Biphasic Isophane Insulin  (Mixtard® 10)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Biphasic Isophane Insulin  (Mixtard® 40)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Biphasic Isophane Insulin  (Mixtard® 20)

    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
     
    Biphasic Isophane Insulin  (Pork Mixtard® 30)

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary




    STOPP v2 recommendation Sulphonylureas with a long duration of action (e.g. glibenclamide, chlorpropamide, glimepiride) inappropriate to use in patients aged 65 years and older with type 2 diabetes mellitus (risk of prolonged hypoglycaemia).
     
    Choriogonadotropin Alfa  (Ovitrelle®)

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Combined cyclical HRT patch  (Evorel® )

    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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
     
    Danazol  (Danol®)

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
     
    Degludec/Liraglutide Insulin  (iDegLira)

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

    This medication has not been granted formulaary status by EKPG

     
    Dessicated thyroid extract  (Armour thyroid®)
    (Nature-Throid®, Westhroid®, Thyroid by Erfa )

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    NHS status See EKPG recommendation - Dessicated Thyroid Extracts- December 2014 (pdf)
    Link  UKMI Q&A: What clinical evidence is there to support the use of “Armour thyroid” or desiccated thyroid extract?
     
    Diazoxide  (Eudemine®)

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Disodium Pamidronate  (Aredia® Dry Powder)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Dutasteride  (Avodart®)

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    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

    THIS PRODUCT HAS BEEN DISCONTINUED

    •  Stop if eGFR < 30 mL/min/1.73 m2
    STOPP v2 recommendation Sulphonylureas with a long duration of action (e.g. glibenclamide, chlorpropamide, glimepiride) inappropriate to use in patients aged 65 years and older with type 2 diabetes mellitus (risk of prolonged hypoglycaemia).

     

     
    Gliquidone  (Glurenorm®)

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

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

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

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

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

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
     
    Ibandronic Acid injection  (Bonviva®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    As of November 2014 determined to be a drug of low priority by East Kent CCGs. These are medicines for which there are safer and more cost effective alternatives.
     
    Ibandronic acid IV infusion  (Bondronat®)

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

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

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Injection Devices  (OptiPen Pro 1®)

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

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

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

    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
     
    Iodine and Iodide
    (Aqueous iodine oral solution)

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

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Liraglutide/Insulin Degludec  (Xultophy®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    Formulary application has been made but not presently prescribable on local NHS
    Not NHS The product is being considered in the Kent & Medway policy recommendation process.
    Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
     
    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
    RedRed
    From 1st April 2013 new NHS use initiation must meet the commissioned criteria of NHS England (NHS England Policy: EO3/P/a) who will fund the use of mecasermin (drug costs, patient follow up and monitoring) within its licensed indications. Prior approval is expected for contract monitoring purposes before commencing treatment for new patients.


    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)
    Link  NHS England Clinical Commissioning Policy: Mecasermin (Increlex®) For Treatment of Growth Failure in Children and Adolescents With Severe Primary Insulin-Like Growth Factor-1 Deficiency
     
    Meters  (Accu-Chek Aviva®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (Accu-Chek® Compact Plus)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (Ascensia Contour®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (Ascensia® Breeze)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (Ascensia® Esprit 2)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (FreeStyle®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (GlucoMen® Glyco)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (GlucoMen® PC)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (GlucoMen® Visio)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (Hypoguard® Supreme)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (MediSense®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (One Touch®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (One Touch® Ultra)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (PocketScan®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (Prestige® Smart System)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Meters  (TrueTrack® Smart System)

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary BNF March 2013 - not recommended
     
    Nateglinide  (Starlix®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Norethisterone  (Micronor® HRT)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogen only HRT patch  (Estradot, Evorel)

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

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

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

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

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Oestrogens for HRT  (Elleste-Duet Conti®)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Red
    NHS continuation
  • NHS England commissioned service. Contact pharmacy for details.

    Star High cost drug reimbursed separately from NHS England tariff (PBR excluded)
  •  
    Pasireotide
    (Cushing's Disease)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    NHS status Not routinely commissioned by NHS England
     
    Pegvisomant  (Somavert®)
    (Acromegaly)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Black
    NHS status Not routinely commissioned by NHS England. A policy is in progress as of April 2014.
     
    Pioglitazone and Metfomin  (Competact®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary




    STOPP v2 recommendation Thiazolidenediones (e.g. rosiglitazone, pioglitazone) inappropriate to use in patients aged 65 years and older with heart failure (risk of exacerbation of heart failure).
     
    Polycal®

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary Soluble tablets
    Not recommended - standard tablets can be crushed and dispersed in water.
    Liquid is available for children

    Critical medication: Omission of this medication in some of its indications can lead to serious patient harm of death. Please see continuity of critical medicines guidelines and procedure how to obtain medicines out of hours.
     
    Prednisone MR

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

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

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary Withdrawn from clinical use





    STOPP v2 recommendation Thiazolidenediones (e.g. rosiglitazone, pioglitazone) inappropriate to use in patients aged 65 years and older with heart failure (risk of exacerbation of heart failure).
    Link  MHRA website
     
    Rosiglitazone and Metformin  (Avandamet®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary Withdrawn from clinical use





    STOPP v2 recommendation Thiazolidenediones (e.g. rosiglitazone, pioglitazone) inappropriate to use in patients aged 65 years and older with heart failure (risk of exacerbation of heart failure).
    Link  MHRA website
     
    Saxagliptin  (Onglyza®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary Warning
    1. Reduce dose to 2.5mg OD if eGFR 30-60 mL/min/1.73 m2
    2. Use with caution if eGFR < 30mL/min/1.73 m2
    Link  Risk of acute pancreatitis. MHRA safety update Sept 12
    Link  Serious hypersensitivity reactions & acute pancreatitis - Dear HCP Letter
     
    Sermorelin  (Geref 50®)

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Sodium Clodronate  (Clasteon®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Strontium Ranelate  (Protelos®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
    The process of further resticting the indications for this drug in Europe commenced on 13th January 2014 and was finalised on 20th February.
  • The drug can only be used to treat osteoporosis when there are no alternatives
  • Not to be used in patients with current or past
    • VTE (DVT/PE)
    • Ischaemic heart disease
    • Cerebrovascular disease
    • Peripheral vascular disease
    Not to be used in patients with uncontrolled hypertension
  • Patients require 6 monthly monitoring for development of the above
  • Link  EMEA recommendation to further restrict Strontium
    Link  MHRA: Strontium warnings about VTE and prolonged immobilisation and skin reactions
    Link  New medicines Profile: Strontium ranelate for osteoporosis in men
    Link  Strontium ranelate (Protelos): risk of serious cardiac disorders—restricted indications, new contraindications, and warnings
    Link  UKMI Q&A: Strontium in renal impairment or renal replacement therapies
     
    Test Strips

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (Active®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (Advantage® Plus)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (Ascensia® Autodisc)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (Ascensia® Microfill)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (Aviva®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (BM-Accutest®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test Strips  (Combur 9®)

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (Compact®)

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (FreeStyle®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (GlucoMen®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (GlucoMen® Visio Sensor)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (Glucotide®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (Hypoguard® Supreme)

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (MediSense® Soft-Sense)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (MediSense® G2)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (MediSense® Optium Plus)

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

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (One Touch®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (One Touch® Ultra)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (PocketScan®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (Prestige® Smart System)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Test strips  (TrueTrack® Smart System)

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

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

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Testosterone and Esters  (Sustanon 100®)

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Testosterone gel  (Tostran®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Testosterone oral  (Restandol Testocaps®)

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    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
     
    Triptorelin  (Gonapeptyl Depot®)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
     
    Triptorelin  (Salvacyl®)

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

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

    Tablets For uterine fibroids. New initiation was  stopped on 9th February 2018 but had been reauthorised under strict conditions from 5th August 2018 which did not take place in local NHS. On 25 March 2020, the  marketing authorisation was suspended and the drug will be removed from market permamently in September 2020 as a safe process for preventing liver injury has not been identified.



    Link  Esmya (ulipristal acetate) and risk of serious liver injury: new restrictions to use and requirements for liver function monitoring before, during, and after treatment
     
    Urinalysis  (Clinitest®)

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

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

    View adult BNF View SPC online View childrens BNF
    Non Formulary WarningReduce dose to 50mg OD if eGFR < 50mL/min/1.73 m2
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Amber

    Requires to be initiated by specialist for repeat GP Prescribing (Purple as per Eclipse East Kent Primary Care Formulary, may be top sliced) If a downloadable EKPG Prescribing Information Sheet exists in the formulary entry for the drug, it, or an URL (shortcut to webpage/document) should be sent to the GP. See also "Hints in how to incorporate documents for medicines information into clinical communications to GPs".  

    Amber 1

    Shared Care (Orange as per Eclipse East Kent Primary Care Formulary). See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    Amber 2

    Shared Care and topsliced (Orange as per Eclipse East Kent Primary Care Formulary) See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    Black

    A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications  

    Blue

    No comment on drug in East Kent Primary Care Formulary (Blue as per Eclipse East Kent Primary Care Formulary)  

    Brown

    Exceptional Use Only (Brown as per Eclipse East Kent Primary Care Formulary)   

    Green

    On East Kent Primary Care Formulary (Pink or Green as per Eclipse East Kent Primary Care Formulary)  

    Grey

    Not assessed/Not recommended (As per Eclipse East Kent Primary Care Formulary)  

    Red

    Hospital Only (As per Eclipse East Kent Primary Care Formulary)  

    RedRed

    Known to be commissioned for local NHS patients but only available to them from another provider than EKHUFT  

    netFormulary