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Herefordshire & Worcestershire
Medicines and Prescribing Committee
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 Formulary Chapter 6: Endocrine system - Full Chapter
06.01  Drugs used in diabetes
06.01.01  Insulins
 note 

PRESCRIBE BY BRAND - All insulins should be prescribed by brand to reduce the risk of error.

Patient familiarity with one brand is important; instructions for use vary between preparations and patient training is required.

06.01.01.01  Short-acting insulins
06.01.01.01  Soluble Insulin
Insulin (Actrapid®)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Insulin (Humulin® S)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Insulin (Insuman® Rapid)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Insulin 500 units/ml (Humulin R ®)
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Unlicensed Drug Unlicensed
Amber

PRESCRIBE BY BRAND


Kwikpen - available (vial discontinued)


Imported unlicensed from United States.


HUMULIN R IS 5 TIMES THE STRENGTH OF STANDARD INSULINS - TAKE GREAT CARE WHEN PRESCRIBING OR ADMINISTERING.

 
Link  MHRA Drug Alert ‘High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error’
 
06.01.01.01  Short-acting human insulin analogues to top
Insulin lispro  (Insulin Lispro Sanofi®)
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First Choice
Green

PRESCRIBE BY BRAND


Insulin Lispro Sanofi® (biosimilar insulin) is the first line insulin lispro 100 units/ml product for new patient initiations.


Insulin Lispro Sanofi® has been shown to be equivalent to Humalog® 100 units/ml in its pharmacokinetic and pharmacodynamic properties. However, as with other biosimilar medicines, some adjustment may be needed if a switch is agreed through a face-face review.


This is a more cost effective preparation than Humalog® 100 units/ml.

 
Insulin aspart (NovoRapid®)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Insulin aspart (Fiasp®)
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Restricted Drug Restricted
Amber

PRESCRIBE BY BRAND


MPC (DEC 2020):


 


Suitable for primary care initiation following diabetes specialist recommendation, with advice.


For restricted use:



  • For pregnant patients with gestational diabetes or pre-existing Type 1 or Type 2 diabetes on insulin, after first line insulin aspart or insulin lispro have been tried and failed.



  • For Type 1 diabetes

    • If first line insulin aspart or insulin lispro have been tried and failed despite treatment optimisation and correction of other factors eg timing of bolus injections, optimised carbohydrate counting, and the patient is:







      • on an insulin pump experiencing persistent problems with postprandial glucose levels OR







      • on basal bolus insulin with persistent postprandial hyperglycaemia and has been considered for a pump.





  • Continued prescribing is supported where the specialist determines significant benefit by 3 months, this may be demonstrated as:

    • reduction in hypoglycaemia/post prandial spikes/increased time in range.



 
 
Insulin glulisine (Apidra®)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Insulin lispro (Humalog®)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Insulin lispro 200 units/mL (Humalog® KwikPen)
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Formulary
Green

PRESCRIBE BY BRAND


Bioequivalent to Humalog 100units/ml and the cost per unit is the same.
This double strength preparation could be useful for patients on large doses of soluble insulin - with associated reduction in waste.

 
Link  MHRA Drug Alert ‘High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error’
 
06.01.01.02  Intermediate- and long-acting insulins
06.01.01.02  Biphasic insulins
Biphasic isophane insulin (Insuman® Comb 15)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Biphasic isophane insulin (Insuman® Comb 25)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Biphasic insulin lispro (Humalog® Mix25)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Biphasic insulin lispro (Humalog® Mix50)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Biphasic isophane insulin (Insuman ®Comb 50)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Biphasic insulin aspart (NovoMix® 30)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Biphasic isophane insulin (Humulin® M3)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
06.01.01.02  Intermediate Acting Insulin
Isophane insulin (Insuman® Basal)
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Formulary
Green

PRESCRIBE BY BRAND



  • For Type 2 diabetes

  • Use human isophane insulin first before insulin analogues

 
 
Isophane insulin (Humulin® I)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
Isophane insulin (Insulatard®)
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Formulary
Green

PRESCRIBE BY BRAND

 
 
06.01.01.02  Long Acting Insulin Analogues
Insulin glargine  (Semglee®)
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First Choice
Green

PRESCRIBE BY BRAND. 


Semglee® (biosimilar insulin) is the first line insulin glargine 100units/ml preparation.


Semglee® has been shown to be equivalent to Lantus® in its pharmacokinetic and pharmacodynamic properties.  However, as with other biosimilar medicines, some dose adjustment may be needed if a switch is agreed through a face-face review. 


 This is a more cost effective preparation than Lantus® and Abasaglar® and is available as a 100 units/mL solution for injection in a pre-filled pen in the same device as Lantus®.

 
Insulin glargine  (Abasaglar®)
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Formulary
Green

PRESCRIBE BY BRAND



 
Link  MHRA Drug Alert ‘High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error’
 
Insulin glargine  (Lantus®)
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Formulary
Green

PRESCRIBE BY BRAND


 
 
Insulin glargine 300 units/mL (Toujeo®)
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Formulary
Amber

PRESCRIBE BY BRAND


High strength insulin glargine - 300 units/ml

Toujeo® is now the most appropriate long-acting insulin for insulin-resistant patients with Type 2 diabetes who need large doses.

Prescribing can be started and maintained in Primary Care as long as it has been discussed and endorsed by a Secondary Care Diabetology Specialist (including Secondary Care DSNs).

Insulin glargine formulations Semglee®/Lantus®/Abasaglar® (glargine 100units/ml) and Toujeo® (glargine 300units/ml) are not bioequivalent and therefore not interchangeable without dose adjustment. Please see Manufacturer's Prescribing Guidance

 
Link  MHRA Drug Alert ‘High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error’
 
Insulin detemir (Levemir®)
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Formulary
Green

PRESCRIBE BY BRAND


Second line to insulin glargine 100units/ml

 
 
Insulin degludec (100 units/ml) (Tresiba®)
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Restricted Drug Restricted
Amber

PRESCRIBE BY BRAND


 


MPC July 2020: Suitable for GP initiation following specialist recommendation, with advice.

Type 1 diabetes: Insulin degludec should be reserved for the following groups of patients with Type 1 diabetes:
• Difficult hypoglycaemia, particularly with loss of warning.
• Recurrent DKA.
• People who do shift work, particularly with a variable shift pattern.
• Patients being considered for pump therapy – would look to try insulin degludec first.
• Patients who are struggling with a pump and are looking for an alternative insulin regimen.

Type 2 diabetes: Insulin degludec should not be needed for Type 2 diabetes, unless there is very difficult hypoglycaemia that does not resolve with other measures. It has been agreed that Toujeo® is now the most appropriate long-acting insulin for insulin-resistant patients with Type 2 diabetes who need large doses.


 


Degludec is available as 100units/ml and 200units/ml, please follow MHRA guidance when prescribing.

 
Link  MHRA: Insulin degludec (Tresiba▼): available in additional higher strength
 
Insulin degludec (200 units/ml) (Tresiba®)
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Restricted Drug Restricted
Amber

PRESCRIBE BY BRAND


 


MPC July 2020: Suitable for GP initiation following specialist recommendation, with advice.

Type 1 diabetes: Insulin degludec should be reserved for the following groups of patients with Type 1 diabetes:
• Difficult hypoglycaemia, particularly with loss of warning.
• Recurrent DKA.
• People who do shift work, particularly with a variable shift pattern.
• Patients being considered for pump therapy – would look to try insulin degludec first.
• Patients who are struggling with a pump and are looking for an alternative insulin regimen.

Type 2 diabetes: Insulin degludec should not be needed for Type 2 diabetes, unless there is very difficult hypoglycaemia that does not resolve with other measures. It has been agreed that Toujeo® is now the most appropriate long-acting insulin for insulin-resistant patients with Type 2 diabetes who need large doses.


 


Degludec is available as 100units/ml and 200units/ml, please follow MHRA guidance when prescribing.

 
Link  MHRA: Insulin degludec (Tresiba▼): available in additional higher strength
 
06.01.01.03  Hypodermic equipment to top
06.01.01.03  Needles
BD VivaTM pen needles
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Formulary
Green
 
 
TriCareTM pen needles
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Formulary
Green
 
 
PROFine pen needles
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Formulary
Green
 
 
BD AutoShield DuoTM safety pen needles
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Restricted Drug Restricted

Only for patients who have thier insulin administered by healthcare professionals.

 
 
06.01.01.03  Lancets
Agamatrix® Ultra Thin Lancets
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Formulary
Green
 
 
CaresensTMLancets
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Formulary
Green
 
 
Fastclix Lancets
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Formulary
Green

A drum of 6 lancets for use with the Fastclix Lancing device only.

 
 
GlucoRx Safety Lancets
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Restricted Drug Restricted

Only for patients having blood glucose tests by a Health Care Professional.

 
 
Mylife Safety Lancets
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Restricted Drug Restricted

Only for patients having blood glucose tests by a Health Care Professional.

 
 
06.01.02  Antidiabetic drugs
06.01.02.01  Sulfonylureas
Gliclazide
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Formulary
Green
 
 
Glipizide
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Formulary
Green
 
 
Tolbutamide
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Formulary
Green
 
 
06.01.02.02  Biguanides to top
Metformin hydrochloride
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First Choice
Green
 
Metformin hydrochloride modified release
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Second Choice
Green

Second line if intolerant to minimum effective dose of immediate release tablets


Modified release metformin preparations of choice on the formulary are:



  • Sukkarto® SR

  • Yaltormin® SR 

 
 
06.01.02.03  Other antidiabetic drugs
06.01.02.03  Alpha glucosidase inhibitors
Acarbose
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Formulary
Green
 
 
06.01.02.03  DPP4 inhibitors (gliptins)
Alogliptin
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First Choice
Green

There does not appear to be any significant clinical advantages over other DPP-4 inhibitors but overall it appears that this is the most cost effective option.

 
Alogliptin with metformin
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Formulary
Green

There does not appear to be any significant clinical advantages over other DPP-4 inhibitors but overall it appears that this is the most cost effective option.

 
 
Sitagliptin
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Formulary
Green

25mg and 50mg doses are available on the formulary to enable dosage adjustment according to renal function.

 
 
Sitagliptin with metformin
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Formulary
Green
 
 
Saxagliptin
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Formulary
Green
 
 
Linagliptin
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Restricted Drug Restricted
Green

For use in patients with renal impairment.

 
 
06.01.02.03  SGLT2 inhibitors
Ertugliflozin
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Formulary
Green

In line with NICE TA572

 
Link  NICE TA 572: Ertugliflozin as monotherapy or with metformin for treating Type 2 Diabetes
 
Canagliflozin
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Formulary
Green

In Line with NICE TA315 and NICE TA390

 
Link  MHRA Drug Safety Update (April 2017): SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes)
Link  NICE TA 315 Canagliflozin in combination therapy for treating type 2 diabetes
Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
 
Dapagliflozin
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Formulary

Green In line with NICE TA288 for patients with type 2 diabetes.(Please note TA288 has been partially updated - see TA418), TA390 and TA418.


Amber In line with NICE TA 597 for patients with type 1 diabetes: Initiation and prescribing of dapagliflozin with insulin in T1DM patients to be retained by secondary care for the first six months, with the request for GPs to take over maintenance prescribing if the specialist deems there to be the required improvement in HbA1c (i.e. at least 0.3%) and the patient has received any additional monitoring guidance and education about increased risk of DKA.


 Amber In line with NICE TA 679 for the treatment of chronic heart failure with reduced ejection fraction.


 

 
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
Link  NICE TA679 Dapagliflozin for treating chronic heart failure with reduced ejection fraction
 
Dapagliflozin with metformin
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Formulary
Green

In line with NICE TA288 'Dapagliflozin in Combination Therapy for Treating Type 2 Diabetes'.

 
Link  NICE TA288 Dapagliflozin in combination therapy for treating type 2 diabetes
 
Empagliflozin
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Formulary
Green

In line with NICE TA336 and TA390

 
Link  NICE TA336: Empagliflozin in combination therapy for treating type 2 diabetes
Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
 
06.01.02.03  GLP1 agonists to top
Semaglutide S/C injection
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First Choice

Green  SEMAGLUTIDE SHOULD BE THE PRODUCT OF CHOICE WHEN A ONCE WEEKLY GLP-1 AGONIST IS TO BE USED.


Amber  When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.  In line with the SPC, caution should be exercised when considering use in patients with diabetic retinopathy treated with insulin.

 
Lixisenatide S/C injection
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First Choice

 Green LIXISENATIDE SHOULD BE THE PRODUCT OF CHOICE WHEN A DAILY   GLP-1 AGONIST IS TO BE USED.


 Amber When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.

 
Dulaglutide S/C injection
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Formulary

 


Green


Amber  When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.

 
 
Exenatide 2mg prolonged release (S/C injection)
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Formulary

 


Green


Amber  When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.


 

 
 
Liraglutide S/C injection
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Formulary

1.8mg dose not recommended.


Green


Amber  When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.

 
 
Semaglutide oral tabletsBlack Triangle (Rybelsus®)
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Formulary

Rybelsus is a tablet for once-daily oral use but has special administration directions:



  • It must be taken on an empty stomach at any time of the day.

  • Patients are required to wait at least 30 minutes before eating/drinking or taking other oral medicinal products. Waiting less than 30 minutes decreases absorption.

  • It should be swallowed whole with a sip of water (up to half a glass of water equivalent to 120 ml).


Green  For patients where a GLP1 analogue is indicated but an oral preparation is more suitable.


Amber  When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin. 


All patients should be reviewed within 6 months of initiation to assess effectiveness.

 
 
06.01.02.03  Meglitinides
Repaglinide
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Formulary
Green

Second line add-on therapy to metformin for patients with irregular eating habits where HbA1c <8.5% 

OR

As an alternative to adding a glitazone in patients failing targets on metformin/sulfonylurea treatments (or on metformin alone where standard sulfonylureas have been problematic, where HbA1c <8.5%)

OR

Occasionally as monotherapy in lean type 2 patients where standard sulfonylureas have resulted in preprandial hypoglycaemia.

 
 
06.01.02.03  Other
06.01.02.03  Thiazolidinediones
Pioglitazone
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Formulary
Green
 
Link  MHRA Drug Safety Update December 2014 - drug-safety-update/insulin-combined-with-pioglitazone-risk-of-cardiac-failure
 
06.01.02.07  Other antidiabetic drugs
06.01.03  Diabetic ketoacidosis to top
Glucomen® Areo blood ketone test strips
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Restricted Drug Restricted
Green

For patients who require ketone testing.

 
 
KetosensTM blood ketone test strips
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Restricted Drug Restricted
Green

For patients who require ketone testing.

 
 
06.01.04  Treatment of hypoglycaemia
Glucagon (GlucaGen® HypoKit)
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Formulary
Green
 
 
GlucoGel®
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Formulary
Green

Formally known as Hypostop®

 
 
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 meters and test strips
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Formulary
Green

Guideline for the choice of blood glucose meters,test strips, lancets and needles in diabetes

 
 
Flash glucose monitoring system
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Restricted Drug Restricted
Amber

Currently the only approved product is FreeStyle Libre.


The prescribing of FreeStyle Libre 2 will be supported once it is available to prescribe on the EMIS GP prescribing system (expected to be at the end of February 2021).


 March 2019: RESTRICTED TO SECONDARY CARE INITIATION in line with:




    • Flash Glucose Monitoring in Adults Commissioning Policy (link below)


 
Link  COVID-19 Interim Publication: Flash Glucose Monitoring - Action Notice
Link  Flash Glucose Monitoring in Adults Commissioning Policy (April 2020)
 
06.01.06  Blood glucose monitoring
Tee 2+TM
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First Choice
Green

For patients with Type 2 Diabetes

 
Wavesense JAZZTM Duo blood glucose test strips
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Formulary
Green

For patients with Type 2 Diabetes

 
 
Performa Nano blood glucose test strips
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Formulary
Green

For patients with Type 2 Diabetes

 
 
CaresensTM PRO blood glucose test strips
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Formulary
Green

For patients with Type 1 Diabetes

 
 
GlucoMen Areo® Sensor blood glucose test strips
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Formulary
Green

For patients with Type 1 Diabetes

 
 
Aviva blood glucose test strips
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Restricted Drug Restricted
Green

For patients who require a carbohydrate counting function and Accu-Chek insulin pumps.

 
 
Caresens® N blood glucose test strips
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Restricted Drug Restricted
Green

For patients with visual impairment and gestational diabetes.

 
 
Contour®Next blood glucose test strips
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Restricted Drug Restricted
Green

For gestational diabetes and Medtronic insulin pumps

 
 
Freestyle Lite
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Restricted Drug Restricted
Green

For patients using Freestyle InsuLinx

 
 
FreeStyle Optium blood glucose test strips
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Restricted Drug Restricted
Green

For use when patients have a history of DKA or very labile blood sugars.

 
 
Mobile blood glucose test cassette
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Restricted Drug Restricted
Green

For patients with needle phobia, paediatrics, visual impairments, dexterity issues with test strip insertion or sharps disposal issues.

 
 
06.01.06  Urinalysis
Test strips (Clinitest®)
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Formulary
Red

Pathology lab only

 
 
Test strips (Combur5® )
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Formulary
Red
 
 
Test strips (Multistix 8SG®)
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Formulary
Red
 
 
Test strips (Multistix SG®)
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Formulary
Red
 
 
Test strips - glucose (Diastix®)
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Formulary
Green
 
 
Test strips - ketones (Ketostix®)
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Formulary
Green
 
 
06.02  Thyroid and Antithyroid drugs
06.02.01  Thyroid hormones to top
Levothyroxine sodium
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Formulary
Green
 
 
Liothyronine Sodium
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Formulary

IN LINE WITH NHSE GUIDANCE LIOTHYRONINE SHOULD ONLY BE INITIATED BY AN NHS ENDOCRINE SPECIALIST















AMBER  TABLETS

Liothyronine has a similar action to levothyroxine but is more rapidly metabolised and has a more rapid effect; 20–25 micrograms is equivalent to 100 micrograms of levothyroxine. Its effects develop after a few hours and disappear within 24 to 48 hours of discontinuing treatment.


RED INJECTION

It may be used in severe hypothyroid states such as hypothyroid coma when a rapid response is desired.


 
Link  NHSE/I: Items which should not routinely be prescribed in primary care: Guidance for CCGs
 
06.02.02  Antithyroid drugs
Carbimazole
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Formulary
Green
 
Link  MHRA Drug Safety Update (Feb 19): Carbimazole - risk of acute pancreatitis
Link  MHRA Drug Safety Update (Feb 19): Carbimazole: increased risk of congenital malformations; strengthened advice on contraception
 
Iodide with iodine
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Formulary
Red
 
 
Propranolol
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Formulary
Green
 
 
Propylthiouracil
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Formulary
Green
 
 
06.03  Corticosteroids
06.03.01  Replacement therapy
Fludrocortisone acetate
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Formulary
Green
 
 
06.03.02  Glucocorticoid therapy
Betamethasone
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Formulary
Green
 
 
Dexamethasone
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Formulary
Green

  • Tablets

  • Oral solution


 

 
 
Hydrocortisone
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Formulary
Green
 
 
Methylprednisolone
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Formulary
Red

In line with NICE CG186.

 
Link  NICE CG186: Multiple Sclerosis in adults; management
 
Methylprednisolone acetate depot injection
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Formulary
Green
 
 
Prednisolone
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Formulary
Green

 




    • Plain tablets (1mg, 2.5mg, 5mg, 10mg, 20mg, 25mg), soluble tablets (5mg) and (5mg/5ml) oral solution unit dose vials are formulary approved.





    • 25mg tablets and 5mg soluble tablets are less cost effective options in primary care so alternatives should be prescribed if possible.





    • Enteric-coated tablets are no longer approved following an APC decision in February 2010.


 
 
Triamcinolone acetonide
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Formulary
Green
 
 
06.04  Sex hormones to top
06.04.01  Female sex hormones
06.04.01.01  Oestrogens and HRT
Combined continuous HRT
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Formulary
Green

For women with uterus - continuous therapy 



  • Femoston® Conti tablets

  • Evorel® Conti patches

  • Elleste-Duet® Conti tablets

  • Kliovance® tablets

 
 
Combined cyclical HRT
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Formulary
Green

For women with uterus - cyclical therapy



  • Elleste-Duet® tablets

  • Femoston® tablets

  • Evorel® Sequi patches


 

 
 
Oestrogen only HRT
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Formulary
Green

For women without uterus - unopposed oestrogen



  • Elleste solo® tablets

  • Evorel® patches

  • Femseven®

  • Oestrogel®

 
 
Tibolone
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Formulary
Green

For persistent breakthrough bleeding only


 

 
Link  MHRA: Tibolone: benefit-risk balance
 
06.04.01.01  Ethinylestradiol
Ethinylestradiol
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Formulary
Amber
 
 
06.04.01.01  Raloxifene
Raloxifene hydrochloride
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Formulary
Green

In line With NICE TA160 and TA161 (Replaces TA87)

 
Link  NICE TA160
Link  NICE TA161
 
06.04.01.01  Oestrogen only tablets to top
06.04.01.01  Oestrogens and progestogen sequential combined therapy
06.04.01.01  Continuous combined therapy
06.04.01.01  Gonadomimetic
06.04.01.01  Selective oestrogen modulator
06.04.01.02  Progestogens to top
Medroxyprogesterone acetate
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Formulary
Green

  • Climanor®

  • Provera®


For the off-label indication of postponement of menstruation specifically for those women that are contraindicated to receive norethisterone due to VTE risk factors - see FSRH guidance.

 
 
Micronised progesterone (oral capsule)
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Restricted Drug Restricted
Green

  • Utrogestan®


OCT 19: Due to HRT stock availability issues, Utrogestan® is available on the formulary, recommended as an option if combination patches are not available; i.e. enabling the option of oestrogen as a patch or gel with an oral progesterone.  

 
 
Norethisterone
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Formulary
Green
 
 
06.04.02  Male sex hormones and antagonists
Testosterone 2% Gel (Tostran®)
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Formulary
Amber

For the treatment of hypoactive sexual desire disorder in post-menopausal women where standard hormone replacement therapy has not been effective

 
 
Testosterone enantate
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Formulary
Amber

Intramuscular injection

 
 
Testosterone undecanoate
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Formulary
Amber

  •  Nebido® 1000mg/4ml solution for intramuscular injection


Only to be prescribed for its licensed indication where frequent administration of an alternative intramuscular preparation is required and/or there are supply issues with the more affordable preparations.

 
 
Testosterone decanoate, isocaproate, phenylpropionate and propionate
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Restricted Drug Restricted
Amber

  • Sustanon® intramuscular injection


 

 
 
06.04.02  Anti-androgens
Cyproterone acetate
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Formulary
Amber
 
Link  Drug Safety Update (Jun 20): Cyproterone acetate - new advice to minimise risk of meningioma
 
06.04.02  Dutasteride and finasteride
Finasteride
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
06.04.03  Anabolic steroids
 note  Available on consultant request only
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
06.05.01  Anti-oestrogens
Clomifene citrate
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Formulary
Red
 
 
06.05.01  Anterior pituitary hormones
Tetracosactide
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Formulary
Red

  •  Synacthen® and Synacthen Depot®

 
 
Somatropin
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Formulary
Amber with Shared Care

Omnitrope® is the first line product of choice for those patients deemed suitable after assessment, in line with NICE TA64/ NICE TA188(Update of TA42)

 
Link  NICE TA188
Link  NICE TA64
 
06.05.01  Gonadotrophins to top
06.05.01  Growth Hormone
06.05.01  Growth hormone receptor antagonists
06.05.01  Thyrotropin
06.05.01  Hypothalmic hormones
06.05.02  Posterior pituitary hormones and antagonists to top
06.05.02  Posterior pituitary hormones
Desmopressin
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Formulary
Green

  • Tablets

  • Melts (60mcg, 120mcg and 240mcg only) £££

  • Nasal spray (10mcg/dose)

  • Nasal solution


 

 
 
Desmopressin
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Formulary
Red

  • Solution for injection


 

 
 
Terlipressin acetate
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Formulary
Red

  • Solution for injection


 

 
 
06.05.02  Antidiuretic hormone antagonists
Tolvaptan
View adult BNF View SPC online View childrens BNF
Formulary
Red

  • Jinarc® only


 


In line with NICE TA 358:Tolvaptan for treating autosomal dominant polycystic kidney disease




    • Samsca® for the treatment of hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion is NHS England commissioned and should only be prescribed by specialist centres.



Drug safety update: tolvaptan (Samsca) -risk of liver injury


NHS England commissioning policy for tolvaptan (Samsca) for the treatment of hyponatraemia secondary to SIADH in patients requiring chemotherapy

 
 
06.06  Drugs affecting bone metabolism
06.06  Osteoporosis
06.06.01  Calcitonin and parathyroid hormone to top
Calcitonin (salmon)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Teriparatide
View adult BNF View SPC online View childrens BNF
Formulary
Amber

In line with NICE TA161 

 
Link  NICE TA161
 
06.06.02  Bisphosphonates and other drugs affecting bone metabolism
06.06.02  Bisphosphonates
Alendronic acid
View adult BNF View SPC online View childrens BNF
First Choice
Green

  • Oral solution (70mg/100mL) is less cost effective; RESTRICTED only to patients unable to take tablets.

  • Effervescent tablet 70mg (Binosto®): NON-FORMULARY following formulary appraisal (June 17)  

 
Ibandronic acid  (solution for injection)
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Formulary
Red

Solution for injection 1mg per 1ml



  • Treatment of osteoporosis in postmenopausal women at increased risk of fracture

  • Treatment of osteoporosis in men at increased risk of fracture (unlicensed use)


 

 
 
Ibandronic acid 150mg tablets
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Formulary
Green

  • Treatment of osteoporosis in postmenopausal women at increased risk of fracture

  • Treatment of osteoporosis in men at increased risk of fracture (unlicensed use)

 
 
Ibandronic acid 50mg tablets
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Restricted Drug Restricted
Red

Indicated in adults for the prevention of skeletal events in patients with breast cancer and bone metastases.

 
 
Pamidronate disodium
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Formulary
Red
 
 
Risedronate sodium
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Formulary
Green
 
 
Sodium clodronate
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Formulary
Amber
 
 
Zolendronic acid
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
06.06.02  Denosumab
Denosumab (Prolia®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

In line with NICE TA204 and  local guidelines for the initiation and on-going treatment of osteoporosis in men and postmenopausal women.

In line with recommendations within NICE Clinical Guideline ng131 on the diagnosis and care of men with prostate cancer and managing adverse effects of hormone treatment, which states that:

      • Do not routinely offer bisphosphonates to prevent osteoporosis in men with prostate cancer having ADT.
      • Consider assessing fracture risk in men with prostate cancer who are having ADT, in line with NICE guidance on osteoporosis fragility fracture (NICE CG 146)
      • Offer bisphosphonates to men who are having ADT and have osteoporosis, and
      • Consider denosumab if bisphosphonates are contraindicated or not tolerated.

 

 
Link  Denosumab (Prolia®), Osteoporosis in Men and Postmenopausal Women – Prescribing Guidelines
Link  Drug Safety Update (Aug 20): Denosumab 60mg (Prolia): increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment
Link  MHRA Drug Safety Update (July 2015): Denosumab (Prolia, Xgeva); intravenous bisphosphonates: osteonecrosis of the jaw - further measures to minimise risk
Link  MHRA Drug Safety Update (July 2017): Denosumab (Prolia, Xgeva): Reports of osteonecrosis of the external auditory canal
Link  NICE TA204: Denosumab for the prevention of osteoporotic fractures in postmenopausal women
 
Denosumab (XGEVA®)
View adult BNF View SPC online View childrens BNF
Formulary
Red

In line with NICE TA265 

 
Link  MHRA Drug Safety Update (July 2015): Denosumab (Xgeva, Prolia); intravenous bisphosphonates: osteonecrosis of the jaw - further measures to minimise risk
Link  MHRA Drug Safety Update (July 2017): Denosumab (Prolia, Xgeva): Reports of osteonecrosis of the external auditory canal
Link  NICE TA265: Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours
 
06.06.02  Strontium renelate
06.07  Other endocrine drugs to top
06.07.01  Bromocriptine and other dopaminergic drugs
Bromocriptine
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Restricted Drug Restricted
Amber

  • Hyperprolactinaemia


 

 
 
Cabergoline
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber

  • Hyperprolactinaemia


 

 
 
06.07.02  Gonadorelin analogues
Buserelin (Suprecur®)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
 
Goserelin (Zoladex®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

  • Zoladex - 3.6mg (monthly)

  • Zoladex L.A. - 10.8mg (3 monthly)

 
 
Leuprorelin Acetate (Prostap DCS®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

  • Prostap SR DCS - 3.75mg (monthly)

  • Prostap 3 DCS - 11.25mg (3 monthly)

 
 
Triptorelin (Decapeptyl®)
View adult BNF View SPC online View childrens BNF
Formulary
Amber

  • Decapeptyl SR - 3mg (monthly)

  • Decapeptyl SR - 11.25mg (3 monthly)

  • Decapeptyl SR - 22.5mg (6 monthly)

 
 
06.07.03  Metyrapone
06.07.04  Somatomedins
 ....
 Non Formulary Items
Exenatide  (Byetta®)

View adult BNF View SPC online View childrens BNF
Non Formulary

*LIXISENATIDE was approved for addition to the formulary in place of the less affordable twice daily exenatide preparation (Byetta®▼)

Pegvisomant

View adult BNF View SPC online View childrens BNF
Non Formulary

NHS England Commissioned Specialist Centres Only - acromegaly

Link  NHSE Clinical Commissioning Policy: Pegvisomant for acromegaly as a third-line treatment (adults)
Test Strips  (Combur 9®)

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  (Medi-Test Combi 5S®)

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®)

View adult BNF View SPC online View childrens BNF
Non Formulary
Vildagliptin  (Galvus®)

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
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

Red

Secondary care only, not to be prescribed in primary care.   

Amber 2

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber with Shared Care

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber

Considered suitable for primary care prescribing following specialist initiation/recommendation.  

Green

Considered appropriate for prescribing in both secondary and primary care. Suitable for initiation in primary care.   

netFormulary