Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

  Patients with Type 1 Diabetes should have access to specialist type 1 diabetes services in line with national guidance. Type 1 Diabetes is a different disease to type 2 diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

  First line insulins for Type 2 Diabetes in line with Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

For use in external portable insulin pumps.

Suitable for prescribing in primary care following recommendation from diabetes specialist only.

  Patients with Type 1 Diabetes should have access to specialist type 1 diabetes services in line with national guidance. Type 1 Diabetes is a different disease to type 2 diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

  First line insulins for Type 2 Diabetes in line with Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

Suitable for prescribing in primary care following recommendation from diabetes specialist only.

Imported from United States.

Fiasp can be initiated in patients following diabetes specialist (CDS and OUH) recommendation and maintenance of register ONLY IF both the following criteria fulfilled:

• Patient is currently on a rapid acting insulin analogue (ie Novorapid, Humalog, Apidra)
• Presence of a mismatch between insulin rise and post prandial glucose rise.

Fiasp^® should NOT be used as the first line prandial insulin for any patient with diabetes. 

APCO May 2017. 

  Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

Consider asking for specialist review-unusual regime to use.

  Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

Biosimilar Insulin Lispro Sanofi is first line choice for NEW patients if insulin lispro is indicated. Existing patients should not be switched unless in line with an agreed protocol. All prescriptions should be written by brand name.

  Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

Biosimilar Insulin Lispro Sanofi is first line choice for NEW patients if insulin lispro is indicated. Existing patients should not be switched unless in line with an agreed protocol. All prescriptions should be written by brand name.

 Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

  Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

APCO January 2019.

Consider asking for specialist review-unusual regime to use.

Treatment should only be initiated on recommendation from the diabetes specialist team (OCDEM or Community Diabetes Service). Degludec can be considered for type 1 or 2 patients who are having more than 2 hypoglycaemic events per week, or have had more than 1 diabetic ketoacidosis episode in the past 12 months, or require a more flexible dosing interval.

All patients MUST be entered into the national degludec audit. Degludec is available as 100units/ml and 200units/ml, please follow MHRA guidance when prescribing.

APCO January 2017.

Treatment should only be initiated on recommendation from the diabetes specialist team (OCDEM or Community Diabetes Service). Degludec can be considered for type 1 or 2 patients who are having more than 2 hypoglycaemic events per week, or have had more than 1 diabetic ketoacidosis episode in the past 12 months, or require a more flexible dosing interval, or who are on a total long acting insulin dose of more than 80 units per day.

All patients MUST be entered into the national degludec audit. Degludec is available as 100units/ml and 200units/ml, please follow MHRA guidance when prescribing.

APCO January 2017.

Initiation by diabetes consultant only with criteria in GLP-1 receptor agonist guidelines.

Also see prescribing information on Xultophy®.

APCO May 2017.

  Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

  Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

On recommendation of the diabetes specialist team (OCDEM or Community Diabetes Service) for patients who are already on optimised complex regime, who have already tried other insulins (including degludec if patient meets criteria) and on a total long acting insulin dose of more than 80 units per day (or lower if they have very limited injections sites or require 3rd party administration).

APCO January 2017.

Note that biosimilar 'Abasaglar' is first line choice for NEW patients if glargine is indicated. Existing patients should not be switched.

  Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

APCO January 2016.

Consider asking for specialist review-unusual regime to use.

  Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

  First line insulins for Type 2 Diabetes in line with Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

Consider asking for specialist review-unusual regime to use.

Consider asking for specialist review-unusual regime to use.

  Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

  Patients with Type 1 Diabetes should have access to specialist Type 1 Diabetes services in line with national guidance. Type 1 Diabetes is a different disease to Type 2 Diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

  First line insulins for Type 2 Diabetes in line with Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

Consider asking for specialist review-unusual regime to use.

  Patients with Type 1 Diabetes are more likely to achieve tight glucose control with a combination of basal and bolus insulin rather than mixed insulin.  Mixed insulin should be reserved for patients who cannot tolerate multiple injections or in whom a trial of multiple injections has resulted in significant hypoglycaemia.

Patients with type 1 diabetes should have access to specialist type 1 diabetes services in line with national guidance. Type 1 diabetes is a different disease to type 2 diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

  Patients with Type 1 Diabetes are more likely to achieve tight glucose control with a combination of basal and bolus insulin rather than mixed insulin.  Mixed insulin should be reserved for patients who cannot tolerate multiple injections or in whom a trial of multiple injections has resulted in significant hypoglycaemia.

Patients with type 1 diabetes should have access to specialist type 1 diabetes services in line with national guidance. Type 1 diabetes is a different disease to type 2 diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

  Patients with Type 1 Diabetes are more likely to achieve tight glucose control with a combination of basal and bolus insulin rather than mixed insulin.  Mixed insulin should be reserved for patients who cannot tolerate multiple injections or in whom a trial of multiple injections has resulted in significant hypoglycaemia.

Patients with type 1 diabetes should have access to specialist type 1 diabetes services in line with national guidance. Type 1 diabetes is a different disease to type 2 diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

  Patients with Type 1 Diabetes are more likely to achieve tight glucose control with a combination of basal and bolus insulin rather than mixed insulin.  Mixed insulin should be reserved for patients who cannot tolerate multiple injections or in whom a trial of multiple injections has resulted in significant hypoglycaemia.

Patients with type 1 diabetes should have access to specialist type 1 diabetes services in line with national guidance. Type 1 diabetes is a different disease to type 2 diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

  First line insulins for Type 2 Diabetes in line with Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

Consider asking for specialist review-unusual regime to use.

  Patients with Type 1 Diabetes are more likely to achieve tight glucose control with a combination of basal and bolus insulin rather than mixed insulin.  Mixed insulin should be reserved for patients who cannot tolerate multiple injections or in whom a trial of multiple injections has resulted in significant hypoglycaemia.

Patients with type 1 diabetes should have access to specialist type 1 diabetes services in line with national guidance. Type 1 diabetes is a different disease to type 2 diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

  Patients with Type 1 Diabetes are more likely to achieve tight glucose control with a combination of basal and bolus insulin rather than mixed insulin.  Mixed insulin should be reserved for patients who cannot tolerate multiple injections or in whom a trial of multiple injections has resulted in significant hypoglycaemia.

Patients with type 1 diabetes should have access to specialist type 1 diabetes services in line with national guidance. Type 1 diabetes is a different disease to type 2 diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

  First line insulins for Type 2 Diabetes in line with Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

  Patients with Type 1 Diabetes are more likely to achieve tight glucose control with a combination of basal and bolus insulin rather than mixed insulin.  Mixed insulin should be reserved for patients who cannot tolerate multiple injections or in whom a trial of multiple injections has resulted in significant hypoglycaemia.

Patients with type 1 diabetes should have access to specialist type 1 diabetes services in line with national guidance. Type 1 diabetes is a different disease to type 2 diabetes with different treatment pathways. Please consider accessing specialist diabetes care for all your patients with Type 1 Diabetes.

   Should not usually be used first line in Type 2 Diabetes. See Insulin Initiation and Adjustment in Type 2 Diabetes Primary Care Guidelines.

 Restricted for use by school staff for small number of primary school age children requiring insulin injections given by school staff and equipment supplied by GP (as per LEA agreement).

APCO September 2018. 

 No GP prescribing, to be supplied by Oxford Health.

APCO November 2014.

BD Viva is first-line choice for insulin pen needles.

APCO November 2018.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles.

APCO November 2016.

Unusual regime to use, review patient. Gliclazide is first line sulfonylurea.

APCO September 2016.

Unusual regime to use, review patient. Gliclazide is first line sulfonylurea.

APCO September 2016.

Unusual regime to use, review patient. Gliclazide is first line sulfonylurea.

APCO September 2016.

Unusual regime to use, review patient. Gliclazide is first line sulfonylurea.

APCO September 2016.

For primary care only if GI intolerance to standard release formulation.

APCO September 2016.

Only for patients with swallowing difficulties.

Drug tariff special.

APCO September 2016.

APCO September 2016.

Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol. 

APCO November 2018. 

Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol. 

APCO November 2018. 

For use in patients with renal impairment. See OCCG DPP4i switch protocol. 

APCO November 2018. 

For use in patients with renal impairment. See OCCG DPP4i switch protocol. 

APCO November 2018. 

Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol. 

APCO November 2018. 

Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol. 

APCO November 2018. 

Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol. 

APCO November 2018. 

Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol. 

APCO November 2018. 

Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol. 

APCO November 2018. 

First line option in line with updated GLP-1 receptor agonist guidelines.

See patient agreement form.

APCO September 2019.

GP can titrate to 1.8mg if partial response. If no response consider one of the more cost effective options

See GLP-1 receptor agonist guidelines and patient agreement form.

APCO September 2019.

First line option in line with updated GLP-1 receptor agonist guidelines (previously for those who would gain benefit from once weekly and can’t have semaglutide).

See patient agreement form.

APCO September 2019.

Existing patients only (unless high CV risk) in line with updated GLP-1 receptor agonist guidelines. 

See patient agreement form.

APCO September 2019.

Restricted to existing patients only.

Prescribe semaglutide as first line prolonged release glucagon–like peptide (GLP-1) receptor agonist treatment in line with GLP-1 receptor agonist guidelines. Existing patients who meet NICE criteria for continuation can continue with treatment.

Not included in the GLP-1 receptor agonist guidelines. See patient agreement form.

APCO September 2019.

Existing patients only (unless high CV risk) in line with updated GLP1 guidelines.

See patient agreement form.

APCO September 2019.

First line option in line with updated GLP1 guidelines (previously for those who would gain benefit from once weekly). If eye disease present, see flowchart. 

See patient agreement form.

APCO September 2019.

For use in specific circumstances only. Consider conversation with specialist before initiation.

APCO September 2016.

For use in specific circumstances only. Consider conversation with specialist before initiation.

APCO September 2016.

Second line option SGLT2i - consider discussion with specialist team.

See SGLT2i checklist, patient information leaflet on DKA risk and OCCG letter to clinicians.

APCO November 2018.

1^st line SGLT2i option for type 2 diabetes (dapagliflozin also first line)

Dapagliflozin has shown CV outcome benefit in primary prevention; empagliflozin, in secondary prevention

See SGLT2i checklist, patient information leaflet on DKA risk and OCCG letter to clinicians.

APCO November 2018.

Second SGLT2i option as monotherapy or with metformin for treating type 2 diabetes, in line with NICE TA 572.

To review the formulary position when cardiovascular outcome data is available. See SGLT2i checklist, patient information leaflet on DKA risk and OCCG letter to clinicians

APCO May 2019.

Second line option SGLT2i - consider discussion with specialist team.

See SGLT2i checklist, patient information leaflet on DKA risk and OCCG letter to clinicians.

APCO November 2018.

1^st line SGLT2i option for type 2 diabetes (empagliflozin also first line).

Dapagliflozin has shown CV outcome benefit in primary prevention; empagliflozin, in secondary prevention.

See SGLT2i checklist, patient information leaflet on DKA risk, and OCCG letter to clinicians.

APCO May 2019.

  For Type 2 Diabetes Mellitus.

APCO September 2016.

  Advanced liver fibrosis associated with non-alcoholic fatty liver disease (NAFLD) as per NICE NG49.

APCO July 2016.

APCO September 2016.

Prescribers in primary care are requested to only prescribe Freestyle Libre® sensors on an NHS prescription, in line with OCCG policy, following receipt of an NHS diabetes specialist clinic request accompanied by a completed patient/carer agreement form. Prescribing should only be undertaken for 6 months unless the clinic confirms continuation for individual patients.

NB. Ensure patient agreement form is completed jointly by patient and NHS diabetes specialist:

• Flash Glucose Monitoring System Patient Agreement (Adult)
• Flash Glucose Monitoring System Patient Agreement (Paediatric)

APCO January 2018.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

Formerly GlucoRx Original Strips. 

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

First line test strip is Finetest Lite. Other blood glucose meters with strips costing <£6 for 50 can also be considered first line.

Clinicians are encouraged to use cost-effective options unless there is a clear need to use other meters. See guidance on Choosing a Blood Glucose Monitoring Meter and Guideline for Blood Glucose Monitoring. 

APCO May 2019.

The Glucomen Areo 2k Meter is favoured at OCDEM and the Community Diabetes Service. Other cost-effective options are GlucoRx HCT Ketone Strips and KetoSens Ketone Strips.

See Ketone Testing And Sick Day Rules Guideline and ketone meter comparison table in Prescribing Point May 2017. 

APCO March 2017.

The Glucomen Areo 2k Meter is favoured at OCDEM and the Community Diabetes Service. Other cost-effective options are GlucoRx HCT Ketone Strips and KetoSens Ketone Strips.

See Ketone Testing And Sick Day Rules Guideline and ketone meter comparison table in Prescribing Point May 2017. 

APCO March 2017.

The Oral Glucose Tolerance Test (OGTT) requires 75g of anhydrous glucose which is equivalent to 113 mL of Polycal Liquid. Dilute the Polycal liquid with extra fluid to a total volume of 200-300mL. See BNF for information.

  Hypothyroidism for:

• Patients currently receiving liothyronine monotherapy
• Levothyroxine + liothyronine combination therapy for new patients with hypothyroidism
• Patients currently receiving liothyronine and levothyroxine combination therapy

OCCG current local guidance has now been updated to be in line with the recently published RMOC guidance (June 2019). Shared care protocol is still in discussion with endocrinology.

 Secondary care use only:

• Liothyronine monotherapy: Oncology for Thyroid and parathyroid disease.

• Liothyronine monotherapy or combination therapy for resistant depression.

APCO November 2019.

Second line for hyperthyroidsm if Carbimazole cannot be tolerated. See Management Guidelines - Thyroid Diseases. 

Specialist prescribing only.

Specialist prescribing only.

Suitable for continuation in primary care following specialist initiation.

Available as a ready to use solution, so may be more suitable for GP emergency bags than Solu-Cortef^®.

Available as a powder to be mixed with water for injection before use.

Specialist prescribing only.

Suitable for continuation in primary care following specialist initiation.

Alternative option if skin allergy or poor absorption with Evorel^® Sequi, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

In line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

NB. Prempak-C has been discontinued.

Alternative option if skin allergy or poor absorption with Evorel^®, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

In line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

NB. Stock supply issues with Premique® Low Dose 0.3mg/1.5mg have been resolved. Premique® 0.625mg/5mg have been discontinued.

Alternative option if skin allergy /poor absorption with Evorel, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

Smaller sized patches consider for higher doses and petite women, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

Consider if previously well on conjugated equine oestrogen, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

Consider if low libido, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

Suitable for continuation in primary care following specialist initiation if intolerant to progestogens, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO November 2017.

For the secondary prevention of osteoporotic fragility fractures in postmenopausal women as per NICE TA161:

• In whom alendronate and either risedronate or editronate are contra-indicated or not tolerated and
• Who also have a combination of T-score, age and number of independent clinical risk factors for fracture.

Raloxifene is not recommended as a treatment option in postmenopausal women for primary prevention of osteoporotic fractures.

As adjunctive progestogen in HRT treatment, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

As adjunctive progestogen in HRT treatment, in line with Oxfordshire HRT formulary and treatment guidance. 

APCO January 2016. 

  Suitable for continuation in primary care following specialist initiation, for prevention of pre-term labour.

Initiated by pre-term labour clinic at 12 weeks and continued by GP until 34 weeks gestation. 

 APCO May 2018. 

  Not recommended for fertility treatment. GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G.
For use by Oxford Fertility Unit only.

Suitable for continuation in primary care following specialist initiation.

For testosterone replacement therapy in line with Shared Care Protocol.

APCO October 2014.

NB. NOW DISCONTINUED, there may be some supply available.

  For testosterone replacement therapy in line with Shared Care Protocol.

APCO October 2014.

  To be initiated by menopause clinic for low libido in menopause / post-menopause when there is no improvement in symptoms on HRT alone. Use in line with Oxfordshire HRT formulary and treatment guidance. 

APCO November 2017.

  For testosterone replacement therapy in line with Shared Care Protocol.

APCO October 2014.

  To be initiated by menopause clinic for low libido in menopause / post-menopause when there is no improvement in symptoms on HRT alone. Use in line with Oxfordshire HRT formulary and treatment guidance. 

APCO November 2017.

For testosterone replacement therapy in line with Shared Care Protocol.

APCO October 2014.

Suitable for continuation in primary care following specialist initiation.

For anovulatory infertility and should only be prescribed by the treating consultant, in line with Clinical Commissioning Policy 11H.

GPs should not prescribe any fertility drugs.

Reserved for those who have proven adherence problems,

in line with NHS South Central Guidance to Support Cost-effective Choice of Growth Hormone (Somatropin) Products.

For adult Shared Care Protocol, see here. 

For paediatric Shared Care Protocol, see here. 

(Other brands in the paediatric Shared Care Protocol include Humatrope®, Norditropin®, Nutropin®).

A needle free option reserved for those with needle phobia, in line with NHS South Central Guidance to Support Cost-effective Choice of Growth Hormone (Somatropin) Products.

For adult Shared Care Protocol, see here. 

For paediatric Shared Care Protocol, see here. 

(Other brands in the paediatric Shared Care Protocol include Humatrope®, Norditropin®, Nutropin®).

Specialist prescribing only for treatment of male infertility.

GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G.

APCO November 2018.

Secondary care use only.

To induce ovulation in women who have not successfully recruited a follicle using other ovulation induction methods, and in male subfertility, to treat hypogonadotrophic hypogonadism to stimulate spermatogenesis.

APCO September 2018.

Secondary care use only. 

Specialist prescribing only.

Specialist prescribing only.

For autosomal dominant polycystic kidney disease.

APCO May 2016.

  For diabetes insipidus. 

  For nocturnal enuresis (oral preparation).

Secondary care use only for nocturnal enuresis.

APCO September 2005.

Specialist prescribing only.

Specialist prescribing only.

  For the secondary prevention of osteoporotic fragility fractures in postmenopausal women in line with Shared Care Protocol and Osteoporosis - Guidance for Fracture Risk Assessment and Prevention in Primary Care.

APCO May 2018.

 For osteoporosis in Men. Funded by specialised commissioning.

APCO July 2019.

  Not recommended for:

• Secondary prevention of osteoporotic fragility fractures in men in line with NICE TA 161 (APCO November 2012).
• Non-union fractures in line with Clinical Commissioning Policy 252. 

For patients who cannot tolerate alendronic acid, as per Guidance for Fracture Risk Assessment and Prevention in Primary Care

APCO May 2018.

Suitable for continuation in primary care following specialist initiation for breast cancer or myeloma patients with hypercalcaemia associated with skeletal metasteses.

APCO November 2006.

Suitable for continuation in primary care following specialist initiation:

• For patients with metastatic breast cancer who cannot tolerate injections (APCO September 2014).
• As an adjuvant treatment in early breast cancer, in line with Guidelines for adjuvant biphosphonate treatment for post-menopausal women with early breast cancer (APCO November 2017). 

Alternative option if Alendronate or Risedronate is not suitable, as per Guidance for Fracture Risk Assessment and Prevention in Primary Care.

APCO May 2018.

For treating osteoporosis in line with Guidance for fracture risk assessment and prevention in primary care, as per NICE TA464.

APCO May 2018.

For hypercalcaemia and skeletal events linked with malignancy.

See Guidelines for adjuvant biphosphonate treatment for post-menopausal women with early breast cancer (APCO November 2017). 

Specialist prescribing for:

• Treating osteoporosis as per NICE TA464 (APCO November 2017).
• Steroid induced osteoporosis (third-line), if not tolerating risedronate 35mg. (APCO March 2010).
• TPN induced osteoporosis (unlicensed) (APCO June 2007).
• Prevention and treatment of steroid induced osteoporosis and secondary prevention in men (APCO July 2017). 

  Third line treatment for primary and secondary prevention of osteoporotic fractures in line with Denosumab for Osteoporosis in Primary Care Guidelines.

APCO May 2018. 

  For treatment of bone loss associated with hormone ablation in men with prostate cancer at increased risk of fractures. NB. This is under review.

APCO September 2010. 

 Secondary care use only

• For the prevention of skeletal-related events in adults with bone metastases from solid tumours as per NICE TA265 (APCO November 2012).
• For tumor induced hypercalcemia. Agreed at MMTC Oct 2019. (APCO November 2019).

  Not recommended for

• preventing complications that result from prostate cancer spreading to the bone as per NICE TA265 (APCO November 2012).
• preventing skeletal-related events in multiple myeloma as per NICE TA549 (APCO January 2019).

Suitable for continuation in primary care following specialist initiation.

Suitable for continuation in primary care following specialist initiation.

Following recommendation from a specialist.

Specialist prescribing only.