Formulary Chapter 6: Endocrine system - Full Chapter
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06.01 |
Drugs used in diabetes |
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06.01.01.01 |
Short-acting insulins |
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Insulin (Actrapid®)
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Formulary
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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.
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Insulin (Humulin® S)
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Formulary
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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.
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Insulin (Insuman® Infusat)
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Formulary
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For use in external portable insulin pumps. Suitable for prescribing in primary care following recommendation from diabetes specialist only.
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Insulin (Insuman® Rapid)
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Formulary
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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.
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Insulin 500units/mL (Humulin R®)
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Formulary
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Suitable for prescribing in primary care following recommendation from diabetes specialist only. Imported from United States.
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Insulin Aspart (Fiasp®)
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Formulary
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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.
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Insulin Aspart (NovoRapid®)
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Formulary
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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.
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Insulin bovine (Hypurin® Bovine Neutral)
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Restricted
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Consider asking for specialist review-unusual regime to use.
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Insulin Glulisine (Apidra®)
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Formulary
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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.
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Insulin Lispro (Humalog®)
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Formulary
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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.
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Insulin Lispro Sanofi
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Formulary
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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.
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Insulin porcine (Hypurin® Porcine Neutral)
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Restricted
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Consider asking for specialist review-unusual regime to use.
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06.01.01.02 |
Intermediate- and long-acting insulins |
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Insulin degludec (Tresiba®) (100 units/ml)
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Formulary
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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.
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MHRA: Insulin degludec (Tresiba▼) - available in additional higher strength
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Insulin degludec (Tresiba®) (200 units/ml)
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Formulary
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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.
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MHRA: Insulin degludec (Tresiba▼) - available in additional higher strength
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Insulin degludec and liraglutide (Xultophy®)
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Formulary
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Initiation by diabetes consultant only with criteria in GLP-1 receptor agonist guidelines.
Also see prescribing information on Xultophy®.
APCO May 2017.
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Insulin Detemir (Levemir®)
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Formulary
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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.
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Insulin Glargine (Lantus®)
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Formulary
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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.
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Insulin Glargine (Toujeo®) (300 units/ml)
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Formulary
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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.
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UKMI Briefing: Product safety assessment report
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Insulin Glargine biosimilar (Abasaglar®)
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Formulary
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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.
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UKMI Briefing: Product safety assessment report
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Insulin Zinc suspension (Hypurin®Bovine Lente)
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Restricted
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Consider asking for specialist review-unusual regime to use.
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Isophane Insulin (Humulin® I)
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Formulary
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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.
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Isophane Insulin (Hypurin® Bovine Isophane)
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Restricted
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Consider asking for specialist review-unusual regime to use.
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Isophane Insulin (Hypurin® Porcine Isophane)
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Restricted
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Consider asking for specialist review-unusual regime to use.
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Isophane Insulin (Insulatard®)
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Formulary
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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.
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Isophane Insulin (Insuman® Basal)
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Formulary
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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.
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Protamine Zinc Insulin (Hypurin® Bovine Protamine Zinc)
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Restricted
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Consider asking for specialist review-unusual regime to use.
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06.01.01.02 |
Biphasic insulins |
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Biphasic Insulin Aspart (NovoMix® 30)
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Formulary
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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.
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Biphasic Insulin Lispro (Humalog® Mix25)
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Formulary
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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.
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Biphasic Insulin Lispro (Humalog® Mix50)
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Formulary
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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.
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Biphasic Isophane Insulin (Humulin® M3)
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Formulary
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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.
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Biphasic Isophane Insulin (Hypurin® Porcine 30/70 Mix)
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Restricted
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Consider asking for specialist review-unusual regime to use.
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Biphasic Isophane Insulin (Insuman® Comb 15)
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Formulary
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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.
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Biphasic Isophane Insulin (Insuman® Comb 25)
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Formulary
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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.
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Biphasic Isophane Insulin (Insuman® Comb 50)
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Formulary
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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.
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06.01.01.03 |
Hypodermic equipment |
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BD Viva (Needles for insulin pens)
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First Choice
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BD Viva is first-line choice for insulin pen needles.
APCO November 2018.
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Neon Verifine Safety (Needles for insulin pens)
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Restricted
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First line insulin safety needle available as most cost-effective. Will replace BD Autoshield Duo as first line
APCO July 2019.
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BD Autoshield needles
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Restricted
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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.
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GlucoRx FinePoint (Needles for insulin pens)
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Formulary
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BD Viva is first-line choice for insulin pen needles.
APCO November 2018.
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Injection Devices (Autopen®)
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Formulary
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Injection Devices (ClikSTAR®)
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Formulary
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Injection Devices (HumaPen®)
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Formulary
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Injection Devices (JuniorSTAR®)
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Formulary
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Injection Devices (NovoPen®)
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Formulary
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Microdot Droplet (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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Mylife Clickfine (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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NovoTwist (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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Omnican Fine (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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PROFine (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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TriCare (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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Unifine Pentips (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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BD Micro-Fine (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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HaemoFine (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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IME-FINE (Needles for insulin pens)
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Restricted
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BD Viva and GlucoRx FinePoint are first-line choices for insulin pen needles. APCO November 2016.
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06.01.02 |
Antidiabetic drugs |
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06.01.02.01 |
Sulphonyureas |
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Gliclazide
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First Choice
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Gliclazide is first line sulfonylurea. APCO September 2016.
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Glibenclamide
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Restricted
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Unusual regime to use, review patient. Gliclazide is first line sulfonylurea. APCO September 2016.
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Glimepiride
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Restricted
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Unusual regime to use, review patient. Gliclazide is first line sulfonylurea. APCO September 2016.
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Glipizide
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Restricted
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Unusual regime to use, review patient. Gliclazide is first line sulfonylurea. APCO September 2016.
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Tolbutamide
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Restricted
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Unusual regime to use, review patient. Gliclazide is first line sulfonylurea. APCO September 2016.
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Metformin Hydrochloride (Standard release)
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First Choice
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APCO September 2016.
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NICE Evidence Summary: Metformin for PCOS in women who are not planning pregnancy
EMA - Use of metformin to treat diabetes now expanded to patients with moderately reduced kidney function
UKMI Q&A: Metformin for polycystic ovary syndrome
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Metformin Hydrochloride (Modified-release)
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Restricted
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For primary care only if GI intolerance to standard release formulation. APCO September 2016.
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Metformin Hydrochloride (Liquid)
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Restricted
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Only for patients with swallowing difficulties. Drug tariff special. APCO September 2016.
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06.01.02.03 |
Other antidiabetic drugs |
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06.01.02.03 |
Alpha glucosidase inhibitors |
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Acarbose (Glucobay®)
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Formulary
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APCO September 2016.
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06.01.02.03 |
DPP4 inhibitors (gliptins) |
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Alogliptin (Vipidia▼®)
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First Choice
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Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol.
APCO November 2018.
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Alogliptin and Metformin (Vipdomet®)
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Formulary
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Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol.
APCO November 2018.
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Alogliptin and Pioglitazone (Incresync®)
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Formulary
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Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol.
APCO November 2018.
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Linagliptin (Trajenta®)
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Restricted
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For use in patients with renal impairment. See OCCG DPP4i switch protocol.
APCO November 2018.
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Linagliptin and Metformin (Jentadueto®)
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Restricted
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For use in patients with renal impairment. See OCCG DPP4i switch protocol.
APCO November 2018.
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Saxagliptin (Onglyza®)
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Restricted
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Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol.
APCO November 2018.
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Serious hypersensitivity reactions & acute pancreatitis - Dear HCP Letter
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Saxagliptin and metformin (Komboglyze®)
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Restricted
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Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol.
APCO November 2018.
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Sitagliptin (Januvia®)
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Restricted
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Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol.
APCO November 2018.
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Sitagliptin and Metformin (Janumet®)
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Restricted
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Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol.
APCO November 2018.
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Vildagliptin (Galvus®)
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Restricted
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Alogliptin is first choice DPP4i. See OCCG DPP4i switch protocol.
APCO November 2018.
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06.01.02.03 |
GLP1 agonists |
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Liraglutide 1.2mg (Victoza®)
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Restricted
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First line option in line with updated GLP-1 receptor agonist guidelines.
See patient agreement form.
APCO September 2019.
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NICE TA203: Diabetes (type 2) - liraglutide
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Liraglutide 1.8mg (Victoza®)
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Restricted
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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.
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Dulaglutide (Trulicity®)
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Restricted
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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.
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NICE Evidence Summary: Dulaglutide for Type 2 diabetes
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Exenatide (Byetta▼®)
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Restricted
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Existing patients only (unless high CV risk) in line with updated GLP-1 receptor agonist guidelines.
See patient agreement form.
APCO September 2019.
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MRHA: Risk of severe pancreatitis and renal failure with Exenatide
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Exenatide prolonged release (Bydureon▼®)
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Restricted
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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.
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MHRA: Risk of severe pancreatitis and renal failure with Exenatide
NICE TA248: MR exenatide
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Lixisenatide (Lyxumia▼®)
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Restricted
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Existing patients only (unless high CV risk) in line with updated GLP1 guidelines.
See patient agreement form.
APCO September 2019.
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Semaglutide (Ozempic®)
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Restricted
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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.
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Nateglinide (Starlix®)
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Restricted
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For use in specific circumstances only. Consider conversation with specialist before initiation. APCO September 2016.
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Repaglinide
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Restricted
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For use in specific circumstances only. Consider conversation with specialist before initiation. APCO September 2016.
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06.01.02.03 |
SGL2 inhibitors |
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Dapagliflozin (Forxiga▼®)
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First Choice
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1st 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.
In combination with insulin for treating type 1 diabetes as per NICE TA597.
APCO November 2019.
For the treatment of chronic heart failure with reduced ejection fraction, in line with NICE TA679.
Heart failure guidance currently under review.
APCO March 2021.
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NICE TA288: Dapagliflozin in combination therapy for treating type 2 diabetes
NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
NICE TA418: Dapagliflozin in triple therapy for treating type 2 diabetes
NICE TA597: Dapagliflozin with insulin for treating type 1 diabetes
NICE TA679: Dapagliflozin for treating chronic heart failure with reduced ejection fraction
MHRA Safety Update: SGLT2 inhibitors - updated advice on the risk of diabetic ketoacidosis
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Empagliflozin (Jardiance▼®)
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First Choice
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1st 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.
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NICE TA336: Empagliflozin for type 2 diabetes
NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
MHRA Safety Update: SGLT2 inhibitors - updated advice on the risk of diabetic ketoacidosis
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Canagliflozin (Invokana▼®)
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Second Choice
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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.
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NICE TA315: Canagliflozin for type 2 diabetes
NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
MHRA Safety Update: SGLT2 inhibitors - updated advice on the risk of diabetic ketoacidosis
MHRA: Risk of Lower Limb Amputation
MHRA: SGLT2 inhibitors - updated advice on increased risk of lower-limb amputation (mainly toes)
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Empagliflozin and Metformin (Synjardy®)
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Formulary
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1st 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.
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MHRA Safety Update: SGLT2 inhibitors - updated advice on the risk of diabetic ketoacidosis
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Ertugliflozin (Steglatro®)
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Formulary
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Second SGLT2i option as monotherapy or with metformin for treating type 2 diabetes, in line with NICE TA572.
Cardiovascular outcome data not comparable to first line choices.
See SGLT2i checklist, patient information leaflet on DKA risk and OCCG letter to clinicians
APCO November 2020
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NICE TA572: Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes
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Canagliflozin and Metformin (Vokanamet®)
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Formulary
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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.
|
MHRA Safety Update: SGLT2 inhibitors - updated advice on the risk of diabetic ketoacidosis
MHRA: SGLT2 inhibitors - updated advice on increased risk of lower-limb amputation (mainly toes)
|
Dapagliflozin and Metformin (Xigduo®)
|
Formulary
|
1st 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.
|
MHRA Safety Update: SGLT2 inhibitors - updated advice on the risk of diabetic ketoacidosis
|
Sotagliflozin
|
Formulary
|
Use with insulin for treating type 1 diabetes as per NICE TA622. Drug is not available yet in the UK - once available this will be discussed again at APCO.
APCO March 2020.
|
NICE TA622: Sotagliflozin with insulin for treating type 1 diabetes
|
|
|
|
|
06.01.02.03 |
Thiazolidinediones |
|
|
Pioglitazone
|
Formulary
|
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.
|
NICE NG49: Non-alcoholic fatty liver disease (NAFLD): assessment and management
MHRA: Risk of bladder cancer with pioglitazone
MHRA: Risk of cardiac failure when pioglitazone combined with insulin
|
Pioglitazone and Metfomin (Competact®)
|
Formulary
|
APCO September 2016.
|
|
06.01.03 |
Diabetic ketoacidosis |
|
|
06.01.04 |
Treatment of hypoglycaemia |
|
|
Glucagon (GlucaGen® HypoKit)
|
Restricted
|
Can be initiated in primary care but seek specialist support to manage hypoglycaemia.
APCO March 2020.
|
|
06.01.04 |
Chronic hypoglycaemia |
|
|
06.01.05 |
Treatment of diabetic nephropathy and neuropathy |
|
|
06.01.06 |
Diagnostic and monitoring agents for diabetes mellitus |
|
|
06.01.06 |
Blood glucose monitoring |
|
|
Freestyle Libre 2®
|
Formulary
|
Prescribers in primary care are requested to only prescribe Freestyle Libre 2® 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:
Please note- to get full benefit of the Freetyle Libre 2® sensors, they must be used with the updated reader.
For existing patients prescribers can switch the sensors over to Freestyle Libre 2 sensors (secondary care input is not needed).
See December 2020 Prescribing points article for full information on switching.
APCO Jan 2021
|
|
FreeStyle Libre®
|
Formulary
|
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:
APCO January 2018.
For existing patients prescribers can switch the sensors over to Freestyle Libre 2 sensors (secondary care input is not needed) an updated reader is required.
See December 2020 Prescribing points article for full information on switching.
|
|
Blood glucose test strip (Accu-Chek® Active)
|
Formulary
|
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.
|
|
Blood glucose test strip (Accu-Chek® Performa )
|
Formulary
|
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.
|
|
Blood glucose test strip (Advocate® Redi-Code+)
|
Formulary
|
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.
|
|
Blood glucose test strip (AutoSense®)
|
Formulary
|
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.
|
|
Blood glucose test strip (Betachek Visual®)
|
Formulary
|
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.
|
|
Blood glucose test strip (CareSens® Pro)
|
Formulary
|
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.
|
|
Blood glucose test strip (Contour®)
|
Formulary
|
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.
|
|
Blood glucose test strip (Contour® TS)
|
Formulary
|
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.
|
|
Blood glucose test strip (Dario® Lite)
|
Formulary
|
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.
|
|
Blood glucose test strip (Element®)
|
Formulary
|
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.
|
|
Blood glucose test strip (Finetest Lite®)
|
Formulary
|
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.
|
|
Blood glucose test strip (Glucoflex-R®)
|
Formulary
|
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.
|
|
Blood glucose test strip (GlucoLab®)
|
Formulary
|
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.
|
|
Blood glucose test strip (GlucoMen® Areo Sensor)
|
Formulary
|
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.
|
|
Blood glucose test strip (Glucomen® GM)
|
Formulary
|
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.
|
|
Blood glucose test strip (GlucoNavii® Glucose)
|
Formulary
|
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.
|
|
Blood glucose test strip (GlucoRx Go®)
|
Formulary
|
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.
|
|
Blood glucose test strip (GlucoRx Nexus®)
|
Formulary
|
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.
|
|
Blood glucose test strip (GlucoRx Q®)
|
Formulary
|
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.
|
|
Blood glucose test strip (GlucoRx® HCT )
|
Formulary
|
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.
|
|
Blood glucose test strip (GlucoZen.auto®)
|
Formulary
|
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.
|
|
Blood glucose test strip (GluNEO®)
|
Formulary
|
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.
|
|
Blood glucose test strip (i-Health®)
|
Formulary
|
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.
|
|
Blood glucose test strip (Microdot®+)
|
Formulary
|
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.
|
|
Blood glucose test strip (Mylife Pura®)
|
Formulary
|
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.
|
|
Blood glucose test strip (Mylife Unio®)
|
Formulary
|
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.
|
|
Blood glucose test strip (Omnitest® 3)
|
Formulary
|
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.
|
|
Blood glucose test strip (Omnitest® 5)
|
Formulary
|
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.
|
|
Blood glucose test strip (One Touch Select® Plus)
|
Formulary
|
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.
|
|
Blood glucose test strip (One Touch Ultra®)
|
Formulary
|
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.
|
|
Blood glucose test strip (Palmdoc®)
|
Formulary
|
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.
|
|
Blood glucose test strip (Palmdoc® iCare Advanced)
|
Formulary
|
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.
|
|
Blood glucose test strip (SD Codefree®)
|
Formulary
|
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.
|
|
Blood glucose test strip (SuperCheck Plus®)
|
Formulary
|
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.
|
|
Blood glucose test strip (SuperCheck2®)
|
Formulary
|
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.
|
|
Blood glucose test strip (SURESIGN Resure®)
|
Formulary
|
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.
|
|
Blood glucose test strip (TEE2®)
|
Formulary
|
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.
|
|
Blood glucose test strip (TRUEyou®)
|
Formulary
|
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.
|
|
Blood glucose test strip (VivaChek Ino®)
|
Formulary
|
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.
|
|
Blood glucose test strip (WaveSense JAZZ®)
|
Formulary
|
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.
|
|
Blood glucose test strip (WaveSense JAZZ® Duo)
|
Formulary
|
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.
|
|
Blood glucose test strip (Accu-Chek® Aviva)
|
Restricted
|
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.
|
|
Blood glucose test strip (Accu-Chek® Mobile)
|
Restricted
|
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.
|
|
Blood glucose test strip (Betachek C50®)
|
Restricted
|
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.
|
|
Blood glucose test strip (Betachek G5®)
|
Restricted
|
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.
|
|
Blood glucose test strip (BGStar®)
|
Restricted
|
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.
|
|
Blood glucose test strip (Breeze 2®)
|
Restricted
|
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.
|
|
Blood glucose test strip (CareSens® N)
|
Restricted
|
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.
|
|
Blood glucose test strip (Compact 3®)
|
Restricted
|
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.
|
|
Blood glucose test strip (Contour® Next)
|
Restricted
|
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.
|
|
Blood glucose test strip (Dario®)
|
Restricted
|
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.
|
|
Blood glucose test strip (eBchek®)
|
Restricted
|
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.
|
|
Blood glucose test strip (FineTouch®)
|
Restricted
|
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.
|
|
Blood glucose test strip (FreeStyle Lite®)
|
Restricted
|
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.
|
|
Blood glucose test strip (FreeStyle Optium®)
|
Restricted
|
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.
|
|
Blood glucose test strip (FreeStyle®)
|
Restricted
|
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.
|
|
Blood glucose test strip (GlucoDock® Glucose)
|
Restricted
|
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.
|
|
Blood glucose test strip (GlucoMen® LX Sensor)
|
Restricted
|
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.
|
|
Blood glucose test strip (GlucoMen® Visio Sensor)
|
Restricted
|
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.
|
|
Blood glucose test strip (IME-DC®)
|
Restricted
|
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.
|
|
Blood glucose test strip (MediSense® SoftSense)
|
Restricted
|
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.
|
|
Blood glucose test strip (MediTouch 2®)
|
Restricted
|
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.
|
|
Blood glucose test strip (MediTouch®)
|
Restricted
|
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.
|
|
Blood glucose test strip (Mendor Discreet®)
|
Restricted
|
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.
|
|
Blood glucose test strip (MODZ®)
|
Restricted
|
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.
|
|
Blood glucose test strip (MyGlucoHealth®)
|
Restricted
|
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.
|
|
Blood glucose test strip (On-Call Advanced®)
|
Restricted
|
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.
|
|
Blood glucose test strip (One Touch® Verio)
|
Restricted
|
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.
|
|
Blood glucose test strip (One Touch® Vita)
|
Restricted
|
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.
|
|
Blood glucose test strip (Palmdoc® iCare Advanced Solo)
|
Restricted
|
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.
|
|
Blood glucose test strip (Sensorcard®)
|
Restricted
|
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.
|
|
Blood glucose test strip (TRUEresult®)
|
Restricted
|
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.
|
|
Blood glucose test strip (TrueTrack® System)
|
Restricted
|
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.
|
|
Blood glucose test strip (GlucoMen® Sensor)
|
Restricted
|
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.
|
|
|
|
|
Test Strips (GlucoMen areo Ketone Sensors®)
|
First Choice
|
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.
|
|
Test Strips (GlucoRx HCT Ketone Test Strips®)
|
First Choice
|
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.
|
|
Test Strips (KetoSens®)
|
First Choice
|
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.
|
|
Protein (Medi-Test® Protein 2)
|
Formulary
|
|
|
Protein test strips (Albustix®)
|
Formulary
|
|
|
Test Strips (Diastix®)
|
Formulary
|
|
|
Test Strips (FreeStyle Optium ß-Ketone Test Strips®)
|
Restricted
|
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.
|
|
Test Strips (GlucoMen LX Ketone Test Strips®)
|
Restricted
|
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.
|
|
|
06.01.06 |
Oral glucose tolerance test |
|
|
Polycal® Liquid
|
Formulary
|
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.
|
|
06.02 |
Thyroid and Antithyroid drugs |
|
|
|
|
06.02.01 |
Thyroid hormones |
|
|
Levothyroxine (Thyroxine)
|
First Choice
|
For treatment of primary hypothyroidism, see Management Guidelines - Thyroid Diseases.
|
UKMI suggested drug monitoring schedule
|
Liothyronine (Triiodothyronine)
|
Formulary
|
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 (APCO November 2019).
-
Restricted to consultant only initiation for combination therapy in the treatment of depression. Contact the OH DTG by email to make an application to use liothyronine. Prescribing MUST be retained by secondary care. See prescribing algorithm and full prescribing guidelines for more details. (APCO November 2020).
|
British Thyroid Association-Frequently Asked Questions for GP’s
British Thyroid Association-Frequently Asked Questions for patients
British Thyroid Association-Information for Endocrinologists
PrescQIPP: Switching liothyronine to levothyroxine
|
06.02.02 |
Antithyroid drugs |
|
|
Carbimazole
|
First Choice
|
First line treatment for hyperthyroidism. See Management Guidelines - Thyroid Disease.
|
UKMI suggested drug monitoring schedule
|
Propylthiouracil
|
Second Choice
|
Second line for hyperthyroidsm if Carbimazole cannot be tolerated. See Management Guidelines - Thyroid Diseases.
|
UKMI suggested drug monitoring schedule
|
Iodine and Iodide (Aqueous iodine oral solution)
|
Formulary
|
Specialist prescribing only.
|
|
Potassium Iodide 60mg capsules
|
Formulary
|
Specialist prescribing only.
|
|
|
06.03.01 |
Replacement therapy |
|
|
Fludrocortisone
|
Formulary
|
Suitable for continuation in primary care following specialist initiation.
|
NICE Evidence Summary - Postural hypotension
|
06.03.02 |
Glucocorticoid therapy |
|
|
Betamethasone (Betnesol®) (tablets)
|
Formulary
|
|
|
Dexamethasone (Tablets/ Injection)
|
Formulary
|
As per licensed indications.
Specialist prescribing only for COVID-19 treatment. Following the publication of the results of the dexamethasone arm of the Recovery trial, dexamethasone has been included on the OH formulary for treatment of patients with Covid-19 in hospital only in line with the guidance in the published CMO letter.
Also see NICE COVID-19 prescribing briefing: corticosteroids.
APCO July 2020.
|
|
Hydrocortisone (tablets)
|
Formulary
|
|
|
Hydrocortisone sodium phosphate (Efcortesol®)
|
Formulary
|
Available as a ready to use solution, so may be more suitable for GP emergency bags than Solu-Cortef®.
|
|
Hydrocortisone sodium succinate (Solu-Cortef®)
|
Formulary
|
Available as a powder to be mixed with water for injection before use.
|
|
Prednisolone (Replacement)
|
Formulary
|
|
UKMI: Prednisolone - Use plain, Not EC Tablets
UKMI: Prednisolone - Use plain, Not Soluble Tablets
|
Betamethasone (Betnesol®) (Injection)
|
Formulary
|
Specialist prescribing only.
|
|
Methylprednisolone
|
Formulary
|
Suitable for continuation in primary care following specialist initiation.
|
NICE CG186: Multiple Sclerosis; management in primary and secondary care.
Cochrane: Oral versus Intravenous Steroids for Treatment of Relapses in Multiple Sclerosis
|
|
|
|
|
|
06.04.01 |
Female sex hormones and their modulators |
|
|
|
|
|
06.04.01.01 |
Oestrogens and HRT |
|
|
Combined continuous HRT patch (Evorel® Conti)
|
First Choice
|
First line transdermal option for combined continuous HRT treatment, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Combined continuous HRT tablet (Kliovance®)
|
First Choice
|
First line oral combined continuous HRT treatment, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Combined cyclical HRT patch (Evorel® Sequi)
|
First Choice
|
First line transdermal sequential/ cyclical combined HRT option, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Combined cyclical HRT tablet (Elleste-Duet®)
|
First Choice
|
First line treatment option for sequential/ cyclical combined HRT treatment, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Oestrogen only HRT patch (Evorel®)
|
First Choice
|
First line transdermal option for oestrogen only HRT, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Oestrogen only HRT tablet (Elleste-Solo®)
|
First Choice
|
First line oral treatment for oestrogen only HRT, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Oestrogens only HRT gel (Sandrena®)
|
First Choice
|
Suitable if patient preference, skin allergy to patches or side effects, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Combined cyclical HRT patch (FemSeven® Sequi)
|
Second Choice
|
Alternative option if skin allergy or poor absorption with Evorel® Sequi, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Combined cyclical HRT tablet (Femoston®, Prempak-C®)
|
Second Choice
|
In line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
NB. Prempak-C has been discontinued.
|
|
Continuous combined HRT patch (FemSeven® Conti)
|
Second Choice
|
Alternative option if skin allergy or poor absorption with Evorel®, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Continuous combined HRT tablet (Indivina®,Angeliq®, Femoston® Conti, Premique® low dose)
|
Second Choice
|
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.
|
|
Oestrogens only HRT patch (Elleste-Solo® MX)
|
Second Choice
|
Alternative option if skin allergy /poor absorption with Evorel, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Oestrogens only HRT patch (Estradot®)
|
Second Choice
|
Smaller sized patches consider for higher doses and petite women, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Oestrogens only HRT tablet (Premarin®)
|
Second Choice
|
Consider if previously well on conjugated equine oestrogen, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Tibolone (Livial®)
|
Second Choice
|
Consider if low libido, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
MHRA: Information on breast cancer risks
|
06.04.01.01 |
Hormone replacement therapy |
|
|
06.04.01.01 |
Ethinylestradiol |
|
|
|
Raloxifene Hydrochloride (Evista®)
|
Restricted
|
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.
|
NICE TA160: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women
NICE TA161: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
|
06.04.01.01 |
Oestrogen only tablets |
|
|
06.04.01.01 |
Oestrogens and progestogen sequential combined therapy |
|
|
06.04.01.01 |
Continuous combined therapy |
|
|
06.04.01.01 |
Gonadomimetic |
|
|
06.04.01.01 |
Selective oestrogen modulator |
|
|
|
Medroxyprogesterone Acetate (Provera®) (HRT)
|
Formulary
|
As adjunctive progestogen in HRT treatment, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Micronised Progesterone (Utrogestan®) (Oral capsule)
|
Formulary
|
As adjunctive progestogen in HRT treatment, in line with Oxfordshire HRT formulary and treatment guidance.
APCO January 2016.
|
|
Norethisterone (Utovlan®)
|
Formulary
|
|
|
Progesterone 400mg (Cyclogest®) (Pessary)
|
Formulary
|
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.
|
|
|
|
06.04.02 |
Male sex hormones and antagonists |
|
|
Mesterolone (Pro-Viron®)
|
Formulary
|
Suitable for continuation in primary care following specialist initiation.
|
|
Testosterone 2% gel (Tostran®)
|
Formulary
|
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.
Note: Do not prescribe Tostran for new patients for this indication
GPs can continue prescribing Tostran for patients currently on this product for this indication, or can switch to Tostran from one of the other testosterone products if requested for any reason, however new patients should not be started for this indication (indication under review). This restriction applies for Tostran only.
APCO November 2020.
|
|
Testosterone 50mg/5g gel (Testim®)
|
Formulary
|
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.
|
|
Testosterone 50mg/5g gel (Testogel®)
|
Formulary
|
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.
|
|
Testosterone Undecanoate (Nebido®) (Injection)
|
Formulary
|
For testosterone replacement therapy in line with Shared Care Protocol.
APCO October 2014.
|
|
|
Cyproterone Acetate (Male hypersexuality)
|
Formulary
|
Suitable for continuation in primary care following specialist initiation.
|
|
Finasteride
|
Formulary
|
|
NICE CG97 Lower urinary tract symptoms in men: quick reference guide
MHRA: Finasteride - rare reports of depression and suicidal thoughts
|
06.04.03 |
Anabolic steroids |
|
|
06.04.04 |
Gender dysphoria |
|
|
06.05 |
Hypothalamic and pituitary hormones and anti-oestrogens |
|
|
06.05.01 |
Hypothalamic and anterior pituitary hormones and anti-oestrogens |
|
|
|
Clomifene Citrate (Clomid®)
|
Formulary
|
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.
|
|
06.05.01 |
Anterior pituitary hormones |
|
|
Somatropin (Omnitrope®, Genotropin®)
|
First Choice
|
First choice products for new patients who are eligible for treatment with growth hormone (in accordance with NICE guidance), 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®).
|
NICE TA188: Somatropin for growth failure in children
NICE TA64: Growth hormone deficiency (adults)
|
Somatropin (Saizen®)
|
Second Choice
|
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®).
|
NICE TA188: Somatropin for growth failure in children
NICE TA64: Growth hormone deficiency (adults)
|
Somatropin (Zomacton®)
|
Second Choice
|
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®).
|
NICE TA188: Somatropin for growth failure in children
NICE TA64: Growth hormone deficiency (adults)
|
Somatropin (Norditropin®)
|
Formulary
|
Second line reserved for unacceptable stinging affecting compliance as per paediatric Shared Care Protocol.
APCO September 2020.
|
|
Choriogonadotropin Alfa (Ovitrelle®)
|
Formulary
|
Specialist prescribing only for treatment of male infertility.
GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G.
APCO November 2018.
|
|
Menotrophin (Human Menopausal Gonadotrophins)
|
Formulary
|
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.
|
|
Tetracosactide (Synacthen®)
|
Formulary
|
Secondary care use only.
|
|
|
06.05.01 |
Hypothalmic hormones |
|
|
Gonadorelin
|
Formulary
|
Specialist prescribing only.
|
|
Protirelin (TRH)
|
Unlicensed
|
Specialist prescribing only.
|
|
06.05.02 |
Posterior pituitary hormones and antagonists |
|
|
Tolvaptan (Jinarc®)
|
Formulary
|
For autosomal dominant polycystic kidney disease. APCO May 2016.
|
NICE TA358: Autosomal dominant polycystic kidney disease - tolvaptan
|
06.05.02 |
Posterior pituitary hormones |
|
|
Desmopressin
|
Formulary
|
For diabetes insipidus.
For nocturnal enuresis (oral preparation).
|
NICE Evidence Summary: Desmopressin for nocturia in men
Patient Safety Alert: Omission of desmopressin can be fatal
Medicines for Children leaflet: Desmopressin for bedwetting
|
Desmopressin (Octim®) (Nasal spray)
|
Formulary
|
Secondary care use only for nocturnal enuresis.
APCO September 2005.
|
|
Terlipressin (Glypressin®)
|
Formulary
|
Specialist prescribing only.
|
|
Vasopressin (Pitressin®)
|
Formulary
|
Specialist prescribing only.
|
|
|
06.05.02 |
Antidiuretic hormone antagonists |
|
|
06.06 |
Drugs affecting bone metabolism |
|
|
|
|
|
|
|
06.06.01 |
Calcitonin and parathyroid hormone |
|
|
Teriparatide (Forsteo®)
|
Formulary
|
*FOR EXISTING PATIENTS ONLY* From February 2021, Movymia will be provided by secondary care.
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.
|
|
Teriparatide (Movymia®)
|
Formulary
|
For the secondary prevention of osteoporotic fragility fractures in postmenopausal women, in line with Osteoporosis - Guidance for Fracture Risk Assessment and Prevention in Primary Care.
APCO January 2021.
|
|
06.06.02 |
Bisphosphonates and other drugs affecting bone metabolism |
|
|
|
Alendronic Acid 70mg tablets
|
First Choice
|
First line treatment for osteoporosis, see Guidance for Fracture Risk Assessment and Prevention in Primary Care.
APCO May 2018.
|
|
Risedronate Sodium 35mg tablets
|
Second Choice
|
For patients who cannot tolerate alendronic acid, as per Guidance for Fracture Risk Assessment and Prevention in Primary Care
APCO May 2018.
|
|
Sodium Clodronate
|
Formulary
|
Suitable for continuation in primary care following specialist initiation for breast cancer or myeloma patients with hypercalcaemia associated with skeletal metasteses. APCO November 2006.
|
|
Ibandronic Acid (50mg tablets)
|
Formulary
|
Suitable for continuation in primary care following specialist initiation:
|
NICE Evidence Summary: Early breast cancer (preventing recurrence and improving survival): adjuvant bisphosphonates
|
Ibandronic Acid (150mg tablets)
|
Formulary
|
Alternative option if Alendronate or Risedronate is not suitable, as per Guidance for Fracture Risk Assessment and Prevention in Primary Care.
APCO May 2018.
|
NICE TA464: Bisphosphonates for treating osteoporosis
|
Ibandronic Acid 3mg injection (Bonviva®) (Osteoporosis )
|
Formulary
|
For treating osteoporosis in line with Guidance for fracture risk assessment and prevention in primary care, as per NICE TA464.
APCO May 2018.
|
NICE TA464: Bisphosphonates for treating osteoporosis
MHRA: Osteonecrosis of the jaw - risk minimisation
|
Pamidronate Disodium
|
Formulary
|
|
MHRA: Osteonecrosis of the jaw - risk minimisation
|
Zoledronic Acid 4mg (Zometa®)
|
Formulary
|
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).
|
MHRA: Osteonecrosis of the jaw - risk minimisation
Osteonecrosis of the jaw patient reminder cards
|
Zoledronic Acid 5mg (Aclasta®)
|
Formulary
|
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).
|
NICE TA464: Bisphosphonates for treating osteoporosis
MHRA: Osteonecrosis of the jaw - risk minimisation
Osteonecrosis of the jaw patient reminder cards
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06.06.02 |
Denosumab |
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Denosumab (Prolia®) (Osteoporosis)
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Formulary
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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.
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NICE CG175: https://www.nice.org.uk/guidance/CG175
NICE TA204: Osteoporotic fractures - denosumab
MHRA Safety Update: Osteonecrosis of the external auditory canal (June 17)
MHRA: Denosumab 60mg (Prolia): increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment
MHRA: Osteonecrosis of the jaw - risk minimisation (July 2015)
MHRA: Risk of osteonecrosis of the jaw and hypocalcaemia (September 14)
MHRA Safety Update: Atypical femoral fracture with long-term use (Febuary 13)
MHRA Safety Update: Hypocalcaemia - monitoring recommended (October 12)
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Denosumab (XGEVA®) (Metastases)
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Formulary
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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).
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NICE TA265: Bone metastases from solid tumours - denosumab: guidance
MHRA Safety Update: Osteonecrosis of the external auditory canal (June 17)
NICE TA549: Denosumab for preventing skeletal-related events in multiple myeloma (terminated appraisal)
MHRA: Osteonecrosis of the jaw - risk minimisation (July 2015)
MHRA: Risk of osteonecrosis of the jaw and hypocalcaemia (September 14)
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06.06.02 |
Strontium renelate |
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06.07 |
Other endocrine drugs |
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06.07.01 |
Bromocriptine and other dopaminergic drugs |
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Bromocriptine (Hyperprolactinaemia)
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Formulary
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Suitable for continuation in primary care following specialist initiation.
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Cabergoline (Hyperprolactinaemia)
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Formulary
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Suitable for continuation in primary care following specialist initiation.
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06.07.02 |
Drugs affecting gonadotrophins |
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06.07.02 |
Gonadorelin analogues |
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Triptorelin (Central Precocious Puberty)
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First Choice
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Initiation by Paediatric Endocrinologist only for Central Precocious Puberty (CPP) in line with Shared Care Protocol.
APCO May 2011.
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06.07.02 |
Breast pain (mastalgia) |
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Metyrapone (Metopirone®)
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Formulary
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Specialist prescribing only.
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Non Formulary Items |
Albiglutide (Eperzan®)

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Non Formulary
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Not included in GLP-1 receptor agonist guidelines.
APCO January 2019. |
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Alendronic Acid with Colecalciferol (Fosavance®)

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Non Formulary
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Armour thyroid®

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Non Formulary
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Use of unlicensed thyroid extracts (e.g. Armour thyroid, ERFA Thyroid), plus compounded thyroid hormones, iodine containing preparations, dietary supplementation are not recommended.
APCO November 2019. |
UKMI Q&A: What clinical evidence is there for “Armour thyroid” or desiccated thyroid extract?
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Bazedoxifene & conjugated oestrogens (Duavive®)

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Non Formulary
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This has been discontinued by the manufacturer. This will be removed from the Oxfordshire HRT formulary and treatment guidance once updated.
APCO March 2021. |
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Biosimilar Insulin Glargine (Semglee®)

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Non Formulary
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Concern that now three different glargine products available but not interchangeable. Still considerable generic prescribing that needs to be reviewed. To be reconsidered in 3-6 months once more work on generic prescribing has been done.
APCO July 2019. |
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Buserelin (Central Precocious Puberty)

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Non Formulary
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Not recommended in line with Central Precocious Puberty (CPP) Shared Care Protocol.
NB. Triptorelin is the only licensed gonadotrophin releasing hormone analogue for CPP.
APCO May 2011. |
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Calcitonin (salmon) (Injection)

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Non Formulary
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For the secondary prevention of osteoporotic fragility fractures in men. APCO November 2012. |
EMA recommendation limiting long term use of calcitonin
Restrictions on use of calcitonin
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Cetrorelix (Cetrotide®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. For use by Oxford Fertility Unit only. |
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Chorionic Gonadotrophin (Choragon®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Chorionic Gonadotrophin (Pregnyl®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Corifollitropin Alfa (Elonva®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Cortisone Acetate (Cortisone)

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Non Formulary
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Danazol (Danol®)

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Non Formulary
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Danazol 100mg and 200mg capsules have been discontinued in the UK (May 2020). All remaining patients will be referred back to OUH for an alternative.
APCO July 2020. |
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Dapagliflozin and Saxagliptin (Qtern®)

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Non Formulary
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Not recommended for use as not in line with NICE guidance. APCO May 2017. |
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Deflazacort (Calcort®)

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Non Formulary
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Diazoxide

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Non Formulary
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Dienogest

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Non Formulary
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Dutasteride (Avodart®)

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Non Formulary
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No evidence of advantage over finasteride or that patients failing on finasteride will benefit from dutasteride.
APCO September 2011. |
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Erfa Thyroid®

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Non Formulary
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Use of unlicensed thyroid extracts (e.g. Armour thyroid, ERFA Thyroid), plus compounded thyroid hormones, iodine containing preparations, dietary supplementation are not recommended.
APCO November 2019. |
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Estradiol hemihydrate transdermal spray (Lenzetto 1.53 mg/spray®)

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Non Formulary
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Not recommended for prescribing until robust review of the evidence by APCO.
APCO March 2021. |
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Ethinylestradiol

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Non Formulary
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Follitropin Alfa (Gonal-F®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Follitropin Alfa and Beta (Puregon®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Follitropin Alfa biosimilar (Bemfola®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Follitropin delta (Rekovelle®)

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Non Formulary
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Ganorelix (Orgalutran®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Gestrinone (Dimetriose®)

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Non Formulary
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Gliclazide (Diamicron® MR)

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Non Formulary
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No clear evidence for using the MR formulation over the immediate release preparation.
APCO September 2011. |
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GlucoGel®

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Non Formulary
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Goserelin (Central Precocious Puberty)

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Non Formulary
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Not recommended in line with Central Precocious Puberty (CPP) Shared Care Protocol.
NB. Triptorelin is the only licensed gonadotrophin releasing hormone analogue for CPP.
APCO May 2011. |
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Human Menopausal Gonadotrophins (Menogon®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Hydrocortisone acetate (Hydrocortisab®)

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Non Formulary
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Hydrocortisone MR (Plenadren®)

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Non Formulary
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No evidence of improved compliance. APCO January 2013. |
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Ibandronic Acid IV infusion (Bondronat®)

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Non Formulary
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Not included in guideline.
APCO September 2014. |
MHRA: Osteonecrosis of the jaw - risk minimisation
NICE TA464: Bisphosphonates for treating osteoporosis
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Insulin 100units/mL (Humulin® R)

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Non Formulary
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Imported from United States. Humulin® S is the equivalent licensed preparation in the UK. |
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Insulin Lispro (Lyumjev ®)

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Non Formulary
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Pending approval from MMTC
APCO November 2020. |
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Ketoconazole (Ketoconazole HRA)

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Non Formulary
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KEYA(r) Smart (Blood glucose and Ketone test strip)

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Non Formulary
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Specialists have not advised on appropriate patient group requiring combined strip.
May be reviewed at a future meeting.
APCO November 2017. |
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Leuprorelin (Central Precocious Puberty)

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Non Formulary
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Not recommended in line with Central Precocious Puberty (CPP) Shared Care Protocol.
NB. Triptorelin is the only licensed gonadotrophin releasing hormone analogue for CPP.
APCO May 2011. |
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Lucozade®

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Non Formulary
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Not suitable for prescribing as not in the Drug Tariff.
Lucozade® have reduced the glucose content in their drinks by almost 50% (from 17g of carbohydrate to 8.9g). Patients should be advised to check the label of any product purchased to ensure that they are aware of the correct quantity to consume. |
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Lutropin Alfa (Luveris®)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Mecasermin (Increlex®)

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Non Formulary
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Commissioning Policy - Mecasermin in Growth Failure
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Medroxyprogesterone Acetate (Climanor®)

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Non Formulary
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Micronised Progesterone (Utrogestan®) (Vaginal capsule)

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Non Formulary
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GPs should not prescribe any fertility drugs as per Clinical Commissioning Policy 11G. |
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Nafarelin (Non-malignant indications)

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Non Formulary
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Nandrolone (Deca-Durabolin®)

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Non Formulary
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Nature Thyroid®

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Non Formulary
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Use of unlicensed thyroid extracts (e.g. Armour thyroid, ERFA Thyroid), plus compounded thyroid hormones, iodine containing preparations, dietary supplementation are not recommended.
APCO November 2019. |
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Oestrogen only HRT gel (Oestrogel)

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Non Formulary
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Oestrogen only HRT implant (Estradiol)

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Non Formulary
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Oestrogens for HRT (Climagest®)

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Non Formulary
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Oestrogens for HRT (Climaval®)

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Non Formulary
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Oestrogens for HRT (Climesse®)

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Non Formulary
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Oestrogens for HRT (Cyclo-Progynova®)

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Non Formulary
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Oestrogens for HRT (Elleste-Duet Conti®)

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Non Formulary
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Oestrogens for HRT (Estracombi®)

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Non Formulary
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Oestrogens for HRT (Estraderm MX®)

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Non Formulary
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Oestrogens for HRT (Estraderm TTS®)

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Non Formulary
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Oestrogens for HRT (Estradiol®)

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Non Formulary
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Oestrogens for HRT (Femapak®)

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Non Formulary
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Oestrogens for HRT (Fematrix®)

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Non Formulary
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Oestrogens for HRT (FemSeven®)

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Non Formulary
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Oestrogens for HRT (FemTab®)

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Non Formulary
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Oestrogens for HRT (FemTab® Sequi)

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Non Formulary
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Oestrogens for HRT (Harmogen®)

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Non Formulary
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Oestrogens for HRT (Hormonin®)

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Non Formulary
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Oestrogens for HRT (Menorin® 50)

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Non Formulary
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Oestrogens for HRT (Novofem®)

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Non Formulary
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Oestrogens for HRT (Nuvelle®)

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Non Formulary
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Oestrogens for HRT (Ovestin®)

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Non Formulary
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Oestrogens for HRT (Progynova®)

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Non Formulary
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