| Formulary Chapter 6: Endocrine system - Full Chapter
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| Chapter Links... |
 Biosimilars policy statement |
| Diabetes UK: Diabetes when you’re unwell |
| LSCMMG: Diabetes - Choice of Safety Pen Needles and Lancets |
| LSCMMG: Diabetes - Pen Needles/Lancets |
| LSCMMG: Diabetes - Position Statement Safety Needles and Safety Lancets |
| LSCMMG: Diabetes Guideline for antihyperglycaemic therapy in adults with type 2 diabetes |
| LSCMMG: Diabetes: Recommended meters, strips and devices |
| LSCMMG: GLP-1 patient contract |
| LSCMMG: Osteoporosis: Secondary fracture prevention patient treatment pathway |
| LSCMMG: Policy for the Provision of Insulin Pumps for Patients with Diabetes Mellitus |
| LSCMMG: Trans Female Gender Dysphoria Information Sheet |
| LSCMMG: Trans Male Gender Dysphoria Information Sheet |
| MHRA: Diabetes and driving |
| NICE NG17: Type 1 diabetes in adults: diagnosis and management |
| NICE NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management |
| NICE NG19: Diabetic foot problems: prevention and management |
| NICE NG28: Type 2 diabetes in adults: management |
| NICE NG3: Diabetes in pregnancy: management from preconception to the postnatal period |
| NHSE guidance to primary care about unregulated providers who supply hormone medications to children and young people for gender incongruence |
| Details... |
| 06.04.01.02 |
Progestogens |
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Medroxyprogesterone Acetate (Provera®)
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Formulary
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Tablets 5mg, 10mg
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Norethisterone (Utovlan®)
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Formulary
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Tablets 5mg
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Progesterone (Prometrium®)
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Formulary
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Vaginal capsules 400mg
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Progesterone (micronised)
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Formulary
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Capsules 100mg
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LSCMMG: Progesterone (micronised) (Utrogestan) NMR
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Progesterone (micronised) (Cyclogest®)
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Formulary
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Pessaries 200mg, 400mg
Used in specialist pre-term birth clinic and for patients with recurring miscarriage following IVF (unlicensed indication)
 Treatment of premenstrual syndrome, including premenstrual tension and depression
Progesterone pessaries are less suitable for prescribing.
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Progesterone (micronised) (Utrogestan ®)
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Formulary
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Vaginal capsules 200mg
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Ulipristal (Esmya®)
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Formulary
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Tablets 5mg
In accordance with NICE NG88, ulipristal should only be used for intermittent treatment of moderate to severe symptoms of uterine fibroids before menopause and when surgical procedures (including uterine fibroid embolisation) are not suitable or have failed.
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 MHRA Drug Safety Update Feb 2021: Ulipristal acetate 5mg (Esmya): further restrictions due to risk of serious liver injury
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Dienogest
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Formulary
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Tablets 2mg
Treatment of endometriosis.
Following specialist recommendation, when combined oral contraceptives and progestogen-only oral contraceptives have proved ineffective or are not tolerated by the patient.
Manufacturer advises that, if contraception is required, females of childbearing potential should use non-hormonal contraception during treatment.
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LSCMMG: Dienogest NMR
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine
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Cancer Drugs Fund
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Homecare |
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ICB commissioned |
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NHS England commissioned |
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Blueteq form needed |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance. |
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