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Wye Valley NHS Trust
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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:

Diabetes Guidelines

 Details...
06.01  Drugs used in diabetes
06.01.01  Insulins
 note 

In type 2 diabetes, long-acting insulin analogues (ie Lantus® glargine and Levemir® detemir) have few advantages over human NPH insulins (i.e. Insulatard®, Humulin I®, Insuman® Basal) but are more expensive. NICE guidance advises analogue insulins should be targeted for use in specific individual patients in which use of human NPH insulins may not be suitable.

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

10ml vial (hospital use & insulin pumps only). All vials are for single patient use.

For local sliding scale information and hyperkalaemia guidelines see intranet

 
   
Insulin (Humulin® S)
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Formulary
Green

 3ml cartridge for Humapen® Savvio

 
   
Insulin aspart (Fiasp®)
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Restricted Drug Restricted
Amber

Very fast acting not interchangeable with NovoRapid

Consultant initiation only. 10ml vial (hospital & insulin pumps only), 3ml cartridges (Fiasp penfill®), disposable pens (Fiasp Flextouch®)

 
   
Insulin Aspart  (NovoRapid®)
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Formulary
Green

10ml vial (hospital & insulin pumps only), 3ml cartridges (Novopen®), disposable pens (Flexpen®)

 
   
Insulin Glulisine (Apidra®)
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Formulary
Green

 3ml cartridge for Clikstar®, 3ml disposable pens Solostar

 
   
Insulin Lispro 100 units/ml (Humalog®)
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Formulary
Green

First line is Insulin Lispro Sanofi (biosimilar). Humalog is retained on formulary for existing patients

10ml vial (hospital & insulin pumps only), 3ml cartridge (Autopen® Classic or Humapen®), disposable pens (Kwikpens®)

 
   
Insulin Lispro Sanofi (biosimilar)
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Formulary
Green

First choice insulin lispro - prescribe by brand Insulin Lispro Sanofi

10ml vial (hospital & insulin pumps only), 3ml cartridge, disposable pens

 
   
06.01.01.02  Intermediate- and long-acting insulins
 note 

In type 2 diabetes, long-acting insulin analogues (ie Lantus® glargine and Levemir® detemir) have few advantages over human NPH insulins (i.e. Insulatard®, Humulin I®, Insuman® Basal) but are more expensive. NICE guidance advises analogue insulins should be targeted for use in specific individual patients in which use of human NPH insulins may not be suitable.

Isophane Insulin (Humulin® I)
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First Choice
Green

In T2DM NICE advises use of NPH insulin rather than insulin analogue first line 

 

3ml cartridge for Humapen® Savvio , 3ml; disposable pens Kwikpen®

 
Isophane Insulin (Insulatard®)
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First Choice
Green

In T2DM NICE advises use of NPH insulin rather than insulin analogue first line 

May be used BD. 3ml Cartridge (Novopen®), Innolet® disposable device

 

 
Isophane Insulin (Insuman® Basal)
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First Choice
Green

In T2DM NICE advises use of NPH insulin rather than insulin analogue first line 

3ml cartridge for Clikstar®, 3ml disposable pens Solostar®

 
Abasaglar® Insulin biosimilar glargine
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Formulary
Green

Retained on formulary for existing patients & those who prefer pen cartridges - first line now Semglee® disposable pens

Abasaglar® 3ml cartridges, disposable pens 100 units/ml KwikPen®

 

 

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

Consultant initiation only – diabetes and paediatrics on an individual patient basis only, for patients who are "pre-pump" 

Long acting insulin analogue

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

CAUTION: HIGH STRENGTH

Consultant initiation only – diabetes and paediatrics on an individual patient basis only, for patients who are "pre-pump" 

 
   
Insulin Detemir (Levemir®)
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Formulary
Green

Long acting insulin analogue

3ml Cartridges (Novopen®), Disposable pens, (Flexpen®), Innolet® disposable injection device. May be used BD.

 
   
Insulin Glargine (Lantus®)
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Formulary
Green

Semglee® disposable pens is first line biosimilar glargine.

Lantus® may be used for patients needing half unit doses.

Lantus® 10ml vial (hospital & insulin pumps only), 3ml cartridges, disposable pens (Solostar®)

 
   
Semglee® Insulin Glargine
(biosimilar insulin glargine )
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Formulary
Green

First choice insulin glargine, long acting analogue

3ml pre-filled disposable pen (NB no cartridge product available)

 
   
06.01.01.02  Biphasic insulins to top
Biphasic Isophane Insulin (Humulin® M3)
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First Choice
Green

Use human isophane insulin first before analogues in type 2 diabetes in line with NICE NG28

3ml cartridges Humapen® Savvio disposable pens Kwikpen®

 
Biphasic Isophane Insulin (Insuman® Comb)
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First Choice
Green

Use human isophane insulin first before analogues in Type 2 diabetes in line with NICE NG28

3ml cartridge for Clickstar® for omb 15 and 50, and also disposable pens Solostar® for Comb 25

 
Biphasic Insulin Aspart (NovoMix® 30)
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Formulary
Green

3ml cartridges (Novopen®). 3ml disposable pens (Flexpen®)

 
   
Biphasic Insulin Lispro (Humalog® Mix)
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Formulary
Green

Mix 25 and 50 - 3ml cartridges (Autopen® Classic or Humapen®), 3ml disposable pens (KwikPens®)

 
   
06.01.01.03  Hypodermic equipment
 note 

4, 5 and 6mm needles are suitable for all people with diabetes regardless of BMI. They may not require a skin fold/pinch up technique, particularly if using 4mm needles. Longer needles may, in some cases, increase potential of inappropriate intramuscular injection of insulin resulting in hypoglycaemia.

BD Viva (4mm)
(Needles for insulin pens)
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Formulary
Green

Prescribe by brand for cost savings and continuity – see guidance for range of needles on formulary which are universal fitting.

 
   
GlucoRx Carepoint
(needles for insulin pens)
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Formulary
Green

Prescribe by brand for cost savings and continuity – see guidance for range of needles on formulary which are universal fitting.

 
   
Omnican fine (32 gauge)
(Needles for insulin pens)
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Formulary
Green

Prescribe by brand for cost savings and continuity – see guidance for range of needles on formulary which are universal fitting.

Prescribe 32 gauge as significantly more cost effective than 31 gauge

 
Link  Needle Guidance
   
Tricare
(Needles for insulin pens)
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Formulary
Green

Prescribe by brand for cost savings and continuity – see guidance for range of needles on formulary which are universal fitting.

 

 
Link  Needle Guidance
   
v BD Autoshield Duo
(Safety Needle for insulin pens)
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Restricted Drug Restricted
Green

Only to be used by District Nurses (supplies via Trust)

Only on FP10 for care home nursing staff use

 
Link  Needle Guidance
   
06.01.02  Antidiabetic drugs
06.01.02.01  Sulphonyureas
Gliclazide
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Formulary
Green

Standard release generic preparation only

 
   
Tolbutamide
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Formulary
Green
 
   
06.01.02.02  Biguanides
Metformin
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First Choice
Green 1

Standard release tablets and licensed oral solution 500mg/5ml (reserved for those with swallowing difficulties or enteral tubes).

Metformin should be reviewed if serum creatinine exceeds 130micromol/L and stopped if it exceeds 150micromol/L, or eGFR falls below 30ml/min

See metformin prescribing newsletter

 
Metformin hydrochloride MR (Sukkarto® SR, Yaltormin® SR)
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Formulary
Green 2

Second line if intolerant to minimum effective dose of standard release tablets.

Prescribe as Sukkarto SR in primary care

 
   
06.01.02.03  Other antidiabetic drugs to top
06.01.02.03  Alpha glucosidase inhibitors
06.01.02.03  DPP4 inhibitors (gliptins)
Alogliptin (Vipidia▼®)
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First Choice
Green

First line DPP4.

Use within NICE recommendations: continue only if HbA1c is reduced by at least 0.5%within six months of starting treatment

 
Linagliptin (Trajenta▼®)
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Formulary
Green

Use within NICE recommendations

Continue only if HbA1c is reduced by at least 0.5%within six months of starting treatment

 
   
Saxagliptin (Onglyza®)
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Formulary
Green

Use within NICE recommendations

Continue only if HbA1cis reduced by at least 0.5%within six months of starting treatment

 
   
Sitagliptin (Januvia®)
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Formulary
Green

Use within NICE recommendations

Continue only if HbA1cis reduced by at least 0.5%within six months of starting treatment

 
   
06.01.02.03  GLP1 agonists
Semaglutide (Ozempic®)
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First Choice
Amber

Semaglutide is the product of choice when a once weekly GLP-1 agonist is to be used.  

NB multidose pen delivers 4 doses ie one pen = one month supply.

Initiation dose 0.25mg once a week, then 0.5mg once a week.

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

 
Dulaglutide (Trulicity®)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

Accepted onto formulary (Apr 2016) as a once weekly preparation in line with NICE NG28 type 2 diabetes guidance for patients who:

•have a BMI of 35 kg/m2 or higher (adjust accordingly for people from black, Asian and other minority ethnic groups) and specific psychological or other medical problems associated with obesity or

•have a BMI lower than 35 kg/m2 and:

◦for whom insulin therapy would have significant occupational implications or

◦weight loss would benefit other significant obesity-related comorbidities. [new 2015]

 

 
   
Exenatide (Byetta▼®)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

NICE recommendation: Consider adding exenatide to metformin and a sulphonylurea if:

 BMI > 35kg/m2 in those of European descent with adjustment for other ethnic groups, and specific psychological or medical problems associated with high body weight

 A BMI > 35kg/m2 and for whom initiation of insulin therapy would have significant occupational implications, or where weight loss would benefit other significant comorbidities

 
   
Exenatide prolonged release (Bydureon▼®)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

Once weekly preparation NICE TA248

Consider adding prolonged-release exenatide to metformin and either a sulphonylurea or a thiazolidinedione if blood glucose levels are not under control, and:

 BMI of 35 or above and have health problems associated with this, or

 BMI of less than 35, and treatment with insulin would make it much more difficult to maintain lifestyle or other significant health problems would be helped by weight loss

 Prolonged-release exenatide can be given with one other drug (metformin or a sulphonylurea) only if:

 patient is not able to take either metformin or a sulphonylurea, and

 patient is not able to take thiazolidinediones and dipeptidyl peptidase-4 (DPP-4) inhibitors

 
Link  NICE TA248: MR exenatide
   
Liraglutide (Victoza®)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

TA203 recommendations as above for exenatide

 
Link  NICE TA203: Diabetes (type 2) - liraglutide
   
Lixisenatide (Lyxumia▼®)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

 
   
06.01.02.03  Meglitinides
06.01.02.03  SGL2 inhibitors to top
Canagliflozin (Invokana▼®)
(SGLT2 inhibitor)
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Formulary
Green 2

As per NICE guidance TA315

 
Link  NICE TA315: Canagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
   
Dapagliflozin (Forxiga▼®)
(SGLT-2 inhibitor)
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Formulary
Green 2

**Care with Dosing**

10mg OD licensed for T2DM

5mg OD licensed for T1DM

 
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
   
Empagliflozin (Jardiance▼®)
(SGLT-2 inhibitor)
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Formulary
Green 2

As per NICE TA336

 
Link  NICE TA336: Empagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
   
Ertugliflozin
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Formulary
Green

As an option in line with NICE guidance

https://www.nice.org.uk/guidance/ta572

https://www.nice.org.uk/guidance/ta583

 
   
06.01.02.03  Thiazolidinediones
Pioglitazone (Actos®)
(Thiazolidinedione)
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Formulary
Green 2

May be used with insulin. Prescribe generically

Discontinue if clinically significant fluid retention occurs; contra-indicated in heart failure

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

See local guidelines for management of hypoglycaemia

Glucagon may also be used in management of beta blocker overdose. See "Emergency treatment of Poisoning" in current BNF and seek specialist advice from poisons centres

 
   
06.01.04  Chronic hypoglycaemia
Diazoxide
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Restricted Drug Restricted
Red

For use in intractable hypoglycaemia. Will be purchased on an individual patient basis

 
   
06.01.05  Treatment of diabetic nephropathy and neuropathy to top
06.01.05  Diabetic nephropathy
06.01.05  Diabetic neuropathy
06.01.06  Diagnostic and monitoring agents for diabetes mellitus
06.01.06  Blood glucose monitoring
Blood Glucose Meters
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Formulary
Advice

Caresens Pro and Ketosens restricted to use for newly diagnosed patients on advice of the diabetic specialist nurses who will provide the meters and advise the patient on use – see new guidance across health economy

 
   
Meters (FreeStyle®)
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Formulary
Advice

Freestyle Precision pro 1st line for use on all wards WVT.

Freestyle Optium and Optium Ketone restricted to use for newly diagnosed patients on advice of the diabetic specialist nurses who will provide the meters and advise the patient on use – see new guidance across health economy

 
   
06.01.06  Urinalysis to top
Test Strips (Diastix®)
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Formulary
Green
 
   
Test Strips (Keto-Diastix®)
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Formulary
Green
 
   
Test Strips (Multistix 8SG®)
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Formulary
Green
 
   
06.01.06  Oral glucose tolerance test
06.02  Thyroid and Antithyroid drugs
06.02.01  Thyroid hormones
Levothyroxine
(Thyroxine)
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First Choice
Green 1
 
Armour thyroid ®
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Restricted Drug Restricted
Red

 Desiccated porcine thyroid gland: see Herefordshire LPT

 
   
Liothyronine
(Triiodothyronine)
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Restricted Drug Restricted
Red

 (Triiodothyronine) hospital use for emergency hypothyroid / myxoedema crisis only – change to levothyroxine as soon as patient is stable. See Herefordshire LPT for further guidance eg NHS psychiatry use.

 
   
Liothyronine
(Triiodothyronine)
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Restricted Drug Restricted
Red

(Triiodothyronine) hospital use for emergency hypothyroid / myxoedema crisis only – change to levothyroxine as soon as patient is stable. See Herefordshire LPT for further guidance eg NHS psychiatry use.

 
   
06.02.02  Antithyroid drugs
Carbimazole (Neo-Mercazole®)
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Formulary
Green

Prescribe generically

 
   
Iodine and Iodide
(Aqueous iodine oral solution)
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Formulary
Green
 
   
Propylthiouracil
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Formulary
Green
 
   
06.03  Corticosteroids to top
06.03.01  Replacement therapy
Fludrocortisone
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Formulary
Green
 
   
06.03.02  Glucocorticoid therapy
Betamethasone (Betnesol®)
(tablets)
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Formulary
Green
 
   
Dexamethasone
(tablets/injection)
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Formulary
Green
 
   
Hydrocortisone
(tablets)
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Formulary
Green
 
   
Hydrocortisone 10mg soluble tablets
(sodium phosphate)
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Formulary
Amber

For paediatric use in adrenal insufficiency

 
   
Methylprednisolone
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Formulary
Green
 
Link  NICE CG186: Multiple Sclerosis; management in primary and secondary care.
   
Prednisolone
(Replacement)
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Formulary
Advice

The EC tablets are not routinely available as the clinical evidence for the benefit of the EC preparation is limited. These are only available if the patient lacks dexterity to half the 5mg (2.5mg EC) or if there is a clear history of intolerance to the plain tablets

There is no rationale to use EC tablets where a PPI or H2 antagonist is also co-prescribed

Soluble tablets are only recommended for administration via feeding tubes. The standard release tablets may be dispersed in water if necessary.

 
   
Triamcinolone (Kenalog®)
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Formulary
Green
 
   
06.03.02  Disadvantages of corticosteroids
06.03.02  Use of corticosteroids
06.03.02  Pregnancy and breastfeeding to top
06.03.02  Administration
06.03.02  Withdrawal of corticosteroids
06.04  Sex hormones
06.04.01  Female sex hormones and their modulators
06.04.01.01  Oestrogens and HRT to top
Combined continuous HRT tablet (Kliofem, Kliovance, Femoston Conti, Premique)
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Formulary
Advice

Kliovance is Formulary

 
   
Combined cyclical HRT tablet (Elleste-Duet®, Femoston, Prempak-C)
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Formulary
Advice

Elleste Duet is Formulary

 
   
Oestrogen only HRT implant (Estradiol)
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Formulary
Green
 
   
Oestrogen only HRT tablet (Elleste-Solo, Premarin)
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Formulary
Green
 
   
Oestrogens for HRT (Elleste-Duet Conti®)
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Formulary
Green
 
   
Tibolone (Livial®)
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Formulary
Green
 
   
06.04.01.01  Hormone replacement therapy
06.04.01.01  Ethinylestradiol
06.04.01.01  Raloxifene
Raloxifene Hydrochloride (Evista®)
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Restricted Drug Restricted
Amber

Restricted to specialist initiation only, second line agent

 
   
06.04.01.01  Oestrogen only tablets
06.04.01.02  Progestogens to top
Dydrogesterone (Duphaston®)
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Formulary
Green
 
   
Dydrogesterone (Duphaston® HRT)
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Formulary
Green
 
   
Medroxyprogesterone Acetate (Provera®)
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Formulary
Green

May also be used by specialist respiratory team in type 2 respiratory failure in post menopausal women (Off label)

 
   
Norethisterone
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Formulary
Green
 
   
Progesterone (micronised) oral capsule (Utrogestan®)
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Formulary
Green

Progestogenic opposition of oestrogen HRT (temporary addition due to medicines shortages Feb20)

 
   
Progesterone pessary (Cyclogest®)
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Formulary
Green
 
   
06.04.02  Male sex hormones and antagonists
Testosterone and Esters (Testogel®)
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Formulary
Advice

In addition to licensed indications this may be used Off-label for reduced libido in women (1 sachet twice weekly) under the recommendation of a specialist gynaecologist

 
   
06.04.02  Anti-androgens
Cyproterone Acetate
(Male hypersexuality)
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Formulary
Green
 
   
Finasteride
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Formulary
Green
 
Link  NICE CG97 Lower urinary tract symptoms: quick reference guide
   
06.04.03  Anabolic steroids
Nandrolone (Deca-Durabolin®)
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Formulary
Green
 
   
06.05  Hypothalamic and pituitary hormones and anti-oestrogens
06.05.01  Hypothalamic and anterior pituitary hormones and anti-oestrogens to top
06.05.01  Anti-oestrogens
Clomifene Citrate
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Restricted Drug Restricted
Red
 
   
Clomifene Citrate (Clomid®)
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Restricted Drug Restricted
Red
 
   
06.05.01  Anterior pituitary hormones
Choriogonadotropin Alfa (Ovitrelle®)
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Restricted Drug Restricted
Amber

Restricted to specialist consultant initiation only

 
   
Chorionic Gonadotrophin (Choragon®)
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Restricted Drug Restricted
Red

Injectable preparation not suitable for primary care prescribing

 
   
Chorionic Gonadotrophin (Pregnyl®)
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Restricted Drug Restricted
Red

Injectable preparation not suitable for primary care prescribing

 

 
   
Somatropin
(Growth hormone)
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Restricted Drug Restricted
Red
High Cost Medicine

All prescribing to be retained by secondary care

 
Link  NICE TA188: Somatropin for growth failure in children
Link  NICE TA64: Growth hormone deficiency (adults)
   
Somatropin (Saizen®)
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Restricted Drug Restricted
Red

All prescribing to be retained by secondary care

 

 
   
Tetracosactide (Synacthen®)
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Formulary
Green
 
   
06.05.01  Hypothalmic hormones
Urofollitropin
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Restricted Drug Restricted
Red

Infertility Treatment, specialist supply only

 

 
   
06.05.02  Posterior pituitary hormones and antagonists
06.05.02  Posterior pituitary hormones to top
Desmopressin
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Formulary
Green

Desmotabs and Desmospray

 
   
Desmopressin (Desmospray®)
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Formulary
Green
 
   
Desmopressin (Desmotabs®)
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Formulary
Green
 
   
Terlipressin (Glypressin®)
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Restricted Drug Restricted
Amber

Restricted to Consultant initiation only

 
   
06.05.02  Antidiuretic hormone antagonists
06.06  Drugs affecting bone metabolism
06.06  Osteoporosis
06.06.01  Calcitonin and parathyroid hormone
Calcitonin (salmon) / Salcatonin
(Nasal spray)
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Restricted Drug Restricted
Amber
 
   
Calcitonin (salmon) / Salcatonin
(Injection)
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Restricted Drug Restricted
Amber
 
   
Parathyroid Hormone (Preotact®)
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Restricted Drug Restricted
Red
High Cost Medicine

Injectable preparation (NHSE commissioned)

 

 
   
Teriparatide (Forsteo®)
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Restricted Drug Restricted
Red
High Cost Medicine

Restricted as per NICE TA161. Prescribing and supply via hospital only

 
   
06.06.02  Bisphosphonates and other drugs affecting bone metabolism to top
06.06.02  Bisphosphonates
Alendronic Acid
(Once-Weekly)
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Formulary
Green 1
 
   
Ibandronic Acid
(osteoporosis)
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Formulary
Green 2

 150mg tablet once a month for osteoporosis

 

 
   
Ibandronic acid IV infusion (Bondronat®)
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Formulary
Green 2

3mg/3ml pre-filled syringe for IV injection every 3 months

 
   
Risedronate
(once weekly)
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Formulary
Green 2
 
   
Sodium Clodronate
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Restricted Drug Restricted
Amber

Restricted to haematology and oncology initiation only (Bonefos)

 
   
Zoledronic Acid
(5mg - Osteoporosis/Paget's)
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Restricted Drug Restricted
Red

Injectable preparation not suitable for primary care prescribing

 

 
   
Zoledronic Acid (4mg - hypercalcaemia/malignancy)
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Restricted Drug Restricted
Red

 Restricted to haematology initiation only

 
   
06.06.02  Denosumab
Denosumab (Prolia®)
(osteoporosis)
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Restricted Drug Restricted
Amber

2nd line agent where a bisphosphonate cannot be tolerated or compliance is an issue in line with NICE – see shared care

 
Link  NICE TA204: Osteoporotic fractures - denosumab
   
06.06.02  Strontium renelate
06.07  Other endocrine drugs
06.07.01  Bromocriptine and other dopaminergic drugs to top
Bromocriptine
(Hyperprolactinaemia)
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Formulary
Green
 
   
Cabergoline
(Hyperprolactinaemia)
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Formulary
Green
 
   
06.07.02  Drugs affecting gonadotrophins
Danazol
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Formulary
Green
 
   
06.07.02  Gonadorelin analogues
Buserelin
(Infertility/ endometriosis)
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Restricted Drug Restricted
Red

Not suitable for primary care cancer or gynaecology indications

 

 
   
Goserelin
(Non- malignant indications)
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Restricted Drug Restricted
Amber
 
   
Leuprorelin (Prostap®)
(Non- malignant indications)
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Formulary
Amber
 
   
Triptorelin
(Non- malignant indications)
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Restricted Drug Restricted
Amber

Decapeptyl SR first line in prostate cancer, also licensed for precocious puberty

 
   
Ulipristal (Esmya®)
(fibroids)
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Formulary
Green 2

August 2018 MHRA advice on updated liver function monitoring and appropriate use.

For pre-operative treatment of moderate to severe symptoms of uterine fibroids, dose 5mg daily for up to 3 months starting during the first week of cycle

NB Prescribe as Esmya® to avoid confusion with EllaOne® (ulipristal 30mg) See 7.3.5 Emergency contraception

 
   
06.07.02  Breast pain (mastalgia)
06.07.03  Metyrapone
06.07.04  Somatomedins to top
 ....
 Non Formulary Items
Abaloparatide

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Non Formulary
 
Acarbose  (Glucobay®)

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Non Formulary
 
Albiglutide  (Eperzan®)

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Non Formulary
 
Alendronic Acid
(Once Daily)

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Non Formulary

Use ONCE WEEKLY generic preparation

 
Alendronic Acid  (Fosamax®)

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Non Formulary

Use ONCE WEEKLY generic preparation

 
Alendronic Acid  (Fosamax® Once Weekly)

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Non Formulary

Prescribe generically

 
Alendronic acid + Colecalciferol  (Fosavance®)

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Non Formulary

Use individual components with vitamin D from a calcium combination preparation eg Calci-D

 

 
Alogliptin / metformin  (Vipdomet®)

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Non Formulary
 
Alogliptin / pioglitazone  (Incresync®)

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Non Formulary
 
Betamethasone  (Betnelan®)

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Non Formulary
 
Betamethasone  (Betnesol®)
(injection - systemic)

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Non Formulary
 
Biphasic Isophane Insulin  (Hypurin® Porcine 30/70 Mix)

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Non Formulary
 
Biphasic Isophane Insulin  (Mixtard® 30)

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Non Formulary
 
Bromocriptine  (Parlodel®)

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Non Formulary

Prescribe generically

 
Canagliflozin / metformin IR  (Vokanamet®)

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Non Formulary
 
Cetrorelix  (Cetrotide®)

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Non Formulary
 
Chlorpropamide

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Non Formulary
 
Combination test strips

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Non Formulary
 
Combined continuous HRT patch  (Evorel® Conti)

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Non Formulary
 
Combined cyclical HRT patch  (Evorel® Sequi)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Conjugated oestrogens + Bazedoxifene  (Duavive®)

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Non Formulary
 
Conjugated oestrogens + Bazedoxifene  (Duavive®)

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Non Formulary
 
Corifollitropin Alfa  (Elonva®)

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Non Formulary
 
Corticorelin

Non Formulary
 
Cortisone Acetate
(Cortisone)

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Non Formulary
 
Cyproterone Acetate  (Androcur®)

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Non Formulary

Prescribe generically

 
Danazol  (Danol®)

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Non Formulary

Prescribe generically

 
Dapagliflozin / metformin  (Xigduo®)

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Non Formulary
 
Deflazacort  (Calcort®)

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Non Formulary
 
Denosumab  (XGEVA®)
(metastases)

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Non Formulary
Link  NICE TA265: Bone metastases from solid tumours - denosumab: guidance
 
Desmopressin  (DDAVP®)

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Non Formulary

Prescribe generically

 
Desmopressin  (DesmoMelt®)

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Non Formulary
 
Desmopressin  (Octim®)

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Non Formulary
 
Dienogest

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Non Formulary
 
Disodium Etidronate  (Didronel PMO®)

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Non Formulary
 
Disodium Etidronate  (Didronel®)

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Non Formulary
 
Disodium Pamidronate

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Non Formulary
 
Disodium Pamidronate  (Aredia® Dry Powder)

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Non Formulary
 
Droplet
(Needles for insulin pens)

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Non Formulary
 
Dutasteride  (Avodart®)

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Non Formulary
 
Empagliflozin + linagliptin  (Glyxambi®)

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Non Formulary
 
Empagliflozin and Metformin  (Synjardy®)

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Non Formulary
 
Ethinylestradiol

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Non Formulary
 
FinePoint
(Needles for insulin pens)

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Non Formulary
Black

 

 

Link  Needle Guidance
 
Follitropin Alfa  (Gonal-F®)

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Non Formulary
 
Follitropin Alfa and Beta  (Puregon®)

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Non Formulary
 
Follitropin Alfa biosimilar  (Bemfola®)

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Non Formulary
 
Follitropin delta  (Rekovelle®)

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Non Formulary
 
FreeStyle Libre®

Non Formulary

See commissioning statement – not currently funded

 

 
Ganorelix  (Orgalutran®)

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Non Formulary
 
Gestrinone  (Dimetriose®)

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Non Formulary
 
Glibenclamide

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Non Formulary

Not to be initiated for NEW patients. Should be switched to a shorter acting sulphonylurea such as gliclazide if hypoglycaemic episodes are a problem 

 
Glibenclamide  (Daonil®)

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Non Formulary
 
Glibenclamide  (Euglucon®)

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Non Formulary
 
Glibenclamide  (Semi-Daonil®)

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Non Formulary
 
Gliclazide  (Diamicron® MR)

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Non Formulary
Not Recomended / Black

Low Value Medicine - see NHSE guidance

 

 
Glimepiride

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Non Formulary
 
Glimepiride  (Amaryl®)

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Non Formulary
 
Glipizide

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Non Formulary
 
Glipizide  (Glibenese®)

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Non Formulary
 
Glipizide  (Minodiab®)

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Non Formulary
 
Gliquidone  (Glurenorm®)

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Non Formulary
 
GlucoGel ®

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Non Formulary
 
Glucose  (Clinistix®)

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Non Formulary
 
Glucose  (Clinitest®)

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Non Formulary
 
Glucose  (Diabur-Test® 5000)

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Non Formulary
 
Glucose  (Diastix®)

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Non Formulary
 
Glucose test strips

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Non Formulary
 
Gonadorelin  (HRF®)

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Non Formulary
 
Human Menopausal Gonadotrophins  (Menogon®)

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Non Formulary
 
Human Menopausal Gonadotrophins  (Menopur®)

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Non Formulary
 
Hydrocortisone acetate  (Hydrocortisab®)

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Non Formulary
 
Hydrocortisone sodium succinate  (Solu-Cortef®)

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Non Formulary
 
Hydrocortisone MR  (Plenadren)

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Non Formulary
 
Ibandronic Acid
(oncology)

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Non Formulary

See Herefordshire LPT

 
Ibandronic Acid injection  (Bonviva®)

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Non Formulary

Prescribe generically

 
Injection Device  (Autopen 24 (1 and 2 unit)®)

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Non Formulary
 
Injection Device  (Autopen Classic (1 and 2 unit)®)

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Non Formulary
 
Injection Device  (ClikStar®)

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Non Formulary
 
Injection Device  (HumaPen Luxura HD®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Injection Device  (HumaPen Savvio®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Injection Device  (NovoPen 5)

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

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

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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®)

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Non Formulary
 
Injection Devices  (SQ-PEN®)

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Non Formulary
 
Insulin  (Exubera®)

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Non Formulary
 
Insulin  (Insuman® Infusat)

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Non Formulary
 
Insulin  (Insuman® Rapid)

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Non Formulary
 
Insulin  (Pork Actrapid®)

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Non Formulary
 
Insulin  (Velosulin®)

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Non Formulary
 
Insulin 500 units in 1mL  (Humulin R®)

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Non Formulary
 
Insulin bovine  (Hypurin® Bovine Neutral)

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Non Formulary
 
Insulin degludec and liraglutide  (Xultophy®)

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Non Formulary
 
Insulin degludec with insulin aspart  (DegludecPlus)

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Non Formulary
 
Insulin Glargine  (Toujeo®)

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Non Formulary
 
Insulin porcine  (Hypurin® Porcine Neutral)

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Non Formulary
 
Insulin Zinc suspension  (Hypurin®Bovine Lente)

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Non Formulary
 
Isophane Insulin  (Hypurin® Bovine Isophane)

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Non Formulary
 
Isophane Insulin  (Hypurin® Porcine Isophane)

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Non Formulary
 
Isophane Insulin  (Pork Insulatard®)

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Non Formulary
 
Ketoconazole  (Ketoconazole HRA)

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Non Formulary
 
Ketones  (Ketur Test®)

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Non Formulary
 
Ketones test strips

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Non Formulary
 
Linagliptin/ metformin  (Jentadueto®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Lixisenatide+ insulin glargine  (Suliqua▼®)

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Non Formulary
 
Lucozade ®

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Non Formulary
 
Lutropin Alfa  (Luveris®)

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Non Formulary
 
Mecasermin  (Increlex®)

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Non Formulary
High Cost Medicine
 
Medroxyprogesterone Acetate  (Climanor®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mesterolone  (Pro-Viron®)

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Non Formulary
 
Meters  (Accu-Chek Aviva®)

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Non Formulary
 
Meters  (Accu-Chek® Compact Plus)

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Non Formulary
 
Meters  (Ascensia Contour®)

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Non Formulary
 
Meters  (Ascensia® Breeze)

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Non Formulary
 
Meters  (Ascensia® Esprit 2)

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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)

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Non Formulary
 
Meters  (MediSense®)

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Non Formulary
 
Meters  (One Touch®)

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Non Formulary
 
Meters  (One Touch® Ultra)

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Non Formulary
 
Meters  (PocketScan®)

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Non Formulary
 
Meters  (Prestige® Smart System)

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Non Formulary
 
Meters  (TrueTrack® Smart System)

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Non Formulary
 
Metformin & pioglitazone  (Competact®)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Metformin Hydrochloride  (Glucophage® SR)

View adult BNF View SPC online View childrens BNF
Non Formulary

In primary care, prescribe as brand Sukkarto SR

Second line where GI intolerance is a problem with plain metformin

 
Metyrapone  (Metopirone®)

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Non Formulary
 
Nafarelin

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Non Formulary
 
Nateglinide  (Starlix®)

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Non Formulary
 
Norethisterone  (Micronor® HRT)

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Non Formulary
 
Norethisterone  (Primolut N®)

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Non Formulary
 
Norethisterone  (Utovlan®)

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Non Formulary
 
Oestrogen only HRT gel  (Oestrogel)

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-Solo® MX)

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  (Menorin® 50)

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  (Nuvelle®)

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
 
Pasireotide

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

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Non Formulary
High Cost Medicine
 
Penfine classic
(Needles for insulin pens)

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Non Formulary
Black
Link  Needle Guidance
 
Pioglitazone and Metfomin  (Competact®)

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Non Formulary
 
Polycal ®

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Non Formulary
 
Potassium Iodide

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Non Formulary
 
Prednisone MR
(Lodotra)

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Non Formulary
 
Progesterone  (Crinone®)

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Non Formulary
 
Progesterone  (Gestone®)

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Non Formulary
 
Progestogen vaginal capsules 200mg  (Utrogestan ®)

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Non Formulary
Black

NOT suitable for primary care prescribing (assisted reproduction via specialist centres only)

 
Protamine Zinc Insulin  (Hypurin® Bovine Protamine Zinc)

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Non Formulary
 
Protein  (Medi-Test® Protein 2)

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Non Formulary
 
Protein test strips  (Albustix®)

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Non Formulary
 
Protirelin  (TRH)

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Non Formulary
 
Quinagolide  (Norprolac®)

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Non Formulary
 
Repaglinide  (Prandin®)

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Non Formulary
 
Risedronate
(daily for Paget's)

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Non Formulary
 
Rosiglitazone  (Avandia®)

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Non Formulary
 
Rosiglitazone and Metformin  (Avandamet®)

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Non Formulary
 
Saxagliptin and dapagliflozin  (Qtern®)

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Non Formulary
 
Saxagliptin and metformin  (Komboglyze®)

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Non Formulary
 
Sermorelin  (Geref 50®)

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Non Formulary
 
Sitagliptin and Metformin  (Janumet®)

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Non Formulary
 
Sodium Clodronate  (Clasteon®)

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Non Formulary
 
Strontium Ranelate  (Protelos®)

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Non Formulary
 
Test strips  (Active®)

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Non Formulary
 
Test strips  (Advantage® Plus)

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Non Formulary
 
Test strips  (Ascensia® Autodisc)

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Non Formulary
 
Test strips  (Ascensia® Microfill)

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Non Formulary
 
Test strips  (Aviva®)

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Non Formulary
 
Test strips  (BM-Accutest®)

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Non Formulary
 
Test Strips  (Combur 9®)

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Non Formulary
 
Test Strips  (Combur5® )

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Non Formulary
 
Test Strips  (Combur7®)

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Non Formulary
 
Test strips  (Compact®)

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Non Formulary
 
Test strips  (FreeStyle®)

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Non Formulary
 
Test strips  (GlucoMen®)

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Non Formulary
 
Test strips  (GlucoMen® Visio Sensor)

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Non Formulary
 
Test strips  (Glucotide®)

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Non Formulary
 
Test strips  (Hypoguard® Supreme)

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Non Formulary
 
Test strips  (MediSense® Soft-Sense)

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Non Formulary
 
Test strips  (MediSense® G2)

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Non Formulary
 
Test strips  (MediSense® Optium Plus)

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Non Formulary
 
Test Strips  (Multistix 10 SG®)

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Non Formulary
 
Test Strips  (Multistix SG®)

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Non Formulary
 
Test Strips  (Multistix®)

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Non Formulary
 
Test strips  (One Touch®)

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Non Formulary
 
Test strips  (One Touch® Ultra)

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Non Formulary
 
Test strips  (PocketScan®)

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Non Formulary
 
Test strips  (Prestige® Smart System)

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Non Formulary
 
Test strips  (TrueTrack® Smart System)

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Non Formulary
 
Test Strips (glucose)

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Non Formulary
 
Testosterone and Esters
(Testosterone enantate)

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Non Formulary
 
Testosterone and Esters  (Andropatch®)

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Non Formulary
 
Testosterone and Esters  (Intrinsa®)

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Non Formulary
 
Testosterone and Esters  (Striant® SR)

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Non Formulary
 
Testosterone and Esters  (Sustanon 100®)

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Non Formulary
 
Testosterone and Esters  (Testim®)

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Non Formulary
 
Testosterone and Esters  (Virormone®)

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Non Formulary
 
Testosterone gel  (Tostran®)

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Non Formulary
 
Testosterone implant

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Non Formulary
 
Testosterone injection  (Sustanon 250®)

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Non Formulary
 
Testosterone oral  (Restandol Testocaps®)

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Non Formulary
 
Testosterone undecanoate  (Nebido®)

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Non Formulary
 
Thyrotropin Alfa  (Thyrogen®)

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Non Formulary
 
Tiludronic Acid  (Skelid®)

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Non Formulary
 
Tolvaptan  (Jinarc®)

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Non Formulary
High Cost Medicine
Link  NICE TA358: Autosomal dominant polycystic kidney disease - tolvaptan
 
Tolvaptan  (Samsca®)

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Non Formulary
High Cost Medicine
Link  NICE TA358: Autosomal dominant polycystic kidney disease - tolvaptan
 
Treatment of hypoglycaemia  (Rapilose® gel)

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Non Formulary
 
Triamcinolone  (Kenalog®)
(Hayfever)

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Non Formulary
 
Trilostane  (Modrenal®)

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Non Formulary
 
Triptorelin  (Gonapeptyl Depot®)

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Non Formulary
 
Triptorelin  (Salvacyl®)

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Non Formulary
 
Urinalysis  (Clinitest®)

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Non Formulary
 
Vasopressin  (Pitressin®)

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Non Formulary
 
Vildagliptin

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Suitable for use in primary care  

Amber

Specialist initiation. Shared care in place  

Red

Red do not use..  

Advice

Some formulations restricted  

Black

NICE "Do not do"  

Green 1

1st line option  

Green 2

2nd line option  

Green 3

3rd line option only  

Not Recomended / Black

Low Value Medicine not recommended for use - see NHSE guidelines  

OTC

This preparation should be bought over the counter for self-care  

Red Amber

Check product description for traffic light status  

Red Black

Low Value Medicine  

netFormulary