BNF Chapter 6

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Endocrine System

BNF CODE – 6.0.0
INSULINNOTES
GuidanceFor patients coming in on NonFormularyDrug (NFD) Insulins wherever possible, use patients own drugs.In extraordinary circumstances NFD INSULINS will be ordered to prevent patients destabilising their usual insulin therapy
SOLUBLE / SHORT ACTING INSULINNOTES
SOLUBLE INSULINHypurin (porcine neutral) vial, Actrapid®
INSULIN ASPARTNovorapid® flexpens, penfill, vial

Fiasp®  flexpens, penfill, vial

 

Fiasp® RESRICTED Use to DIABETES TEAM ONLY

Fiasp for treating Diabetes Mellitus PCN Policy Statement

INSULIN GLULISINEApidra® Solostar penRESTRICTED Use DIABETES TEAM ONLY
INSULIN LISPRO
Humalog® kwikpen, cartridges
BNF CODE – 6.1.1.2
INTERMEDIATE & LONG ACTING INSULINSNOTES
INSULIN DEGLUDECTresiba® 100 units/ml, 200 units/ml pre-filled pen

Tresiba® 100units/ml catridges

RESTRICTED USE: DIABETES TEAM ONLY

 

 

Tresiba® cartridges for prescribing in out-patients

INSULIN DETEMIRLevemir® flexpen, Innolet, cartridgesRESTRICTED USE: DIABETES TEAM ONLY
INSULIN GLARGINELantus® Cartridges, Solostar pensRESTRICTED USE: DIABETES TEAM ONLY
NICE Guidance on Insulin Glargine (2002)
INSULIN GLARGINEToujeo ®  300 units /ml pre-filled penRESTRICTED USE: DIABETES TEAM ONLY
ISOPHANE INSULINInsulatard® cartridges, Innolet, Insuman®Basal Solostar pen
BIPHASIC INSULINS NOTES
BIPHASIC ASPARTNovomix® 30 flexpen, cartridges, vial
BIPHASIC LISPRO

 

Humalog® Mix 25 cartridges, Kwikpen

Humalog ® Mix 50 Kwikpen

BIPHASIC ISOPHANEHumulin M3 cartridges, KwikpenThis brand of Humulin has been put onto Formulary to replace Mixtard 30
BNF CODE – 6.1.2
ORAL ANTIDIABETIC DRUGS                        NOTES
GLICLAZIDETablets 40mg, 80mg

MR 30mg

 

(MR restricted use; diabetes team only)

GLIMEPIRIDETablets 1mg, 3mg
GLIPIZIDE 2.5mg & 5mg TabletsTablets 2.5mg, 5mg
METFORMINTablets 500mg, 850mg

SR Tablets 500mg, 750mg, 1g

Liquid 500mg in 5ml (restricted to enteral tubes and patients unable to swallow tablets)

BNF CODE – 6.1.2.3
OTHER ANTI-DIABETICS      NOTES
SURREY CCG DIABETES PATHWAYCCG Type 2 Diabetes Prescribing Guidelines
 NICE GuidanceNICE Guidance Canagliflozin, Dapagliflozin and Empagliflozin as monotherapies for treating Type 2 Diabetes
CANAGLIFLOZIN Tablets 100mg, 300mgRESTRICTED Use: DIABETES INITATION ONLY 
NICE TAG Canagliflozin
PCN Policy Statement

Drug Safety Update March 2017 – updated advice on increased risk of lower limb amputation (mainly toes)

DAPAGLIFLOZIN Tablets 5mg, 10mgRESTRICTED Use: DIABETES INITATION ONLY 
NICE TA418 Dapagliflozin

PCN Dapagliflozin
EMPAGLIFLOZIN Tablets 10mg, 25mgRESTRICTED Use: DIABETES INITATION ONLY
 NICE Empagliflozin
 ERTUGLIFLOZIN 5mg, 15mg tabletsNICE TA 572: Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes
 DULAGLUTIDEInjection (Trucility) PF pen RESTRICTED Use: DIABETES INITATION ONLY

PCN Dulaglutide

EXENATIDE PF pen (Byetta) 5micrograms, 10micrograms

Injection (Bydureon) 2mg vial, 2mg pen – once weekly administration

RESTRICTED Use : DIABETES INITIATION ONLY
NICE CG New Diabetes Agents
NICE TAG Bydureon
LIRAGLUTIDE PF pen 6mg/ml, 3mlRESTRICTED Use : DIABETES INITIATION ONLY
NICE TA 203: LiraglutideNote: Liraglutide is consider ‘BLACK’ by APC for use in weight management and is not on the formulary for this indication.APC Policy statement: Liraglutide (Saxenda) for weight management
LIXISENATIDE PF Pen 10micrograms, 20 microgramsRESTRICTED Use : DIABETES INITIATION ONLY
NICE CG New Diabetes Agents
NICE Lixisenatide ESNM
PCN Lixisenatide
NATEGLINIDE 60 mg TabletsTablets 60mgRESTRICTED Use : DIABETES TEAM ONLY
PIOGLITIZONETablets 30mg, 45mgRESTRICTED Use : DIABETES TEAM ONLY
NICE CG New Diabetes Agents
EMEA Ruling on Glitazones (2007)
FDA Ruling on Glitazones (2007)
PIOGLITAZONE/METFORMIN (COMPETACT)Tablets
LINAGLIPTIN Tablets 5mgRESTRICTED Use : DIABETES TEAM ONLY
NICE CG New Diabetes Agents
SITAGLIPTIN Tablets 100mgRESTRICTED Use : DIABETES TEAM ONLY
NICE CG New Diabetes Agents
BNF CODE – 6.1.4
TREATMENT OF HYPOGLYCAEMIANOTES
GLUCAGON (GlucaGen HypoKit)1mg powder for injection (pre-filled syringe)Used for acute hypoglycaemia
GLUCOGELOral dextrose 40% gelUsed for acute hypoglycaemia
GLUCOSE 10 % Injection (10ml)
25 % Injection (25ml)
50 % Injection (50ml)
Also used in lower UTI & prostatitis
DIAZOXIDE Liquid 50mg in 1mlUNLICENSED
Paediatrics Only
BNF CODE – 6.2.0
THYROID AND ANTITHYROID DRUGSNOTES
LEVOTHYROXINE SODIUMTablets 25micrograms, 50micrograms, 100microgramsUKMi Interaction between Orlistat & Thyroxine
LIOTHYRONINETablet 20microgramsHypothyroidism with inadequate response or intolerance to levothyroxine.

APC statement: Liothyronine for hypothyroidism

LIOTHYRONINETablet 20microgramsMonotherapy in oncology – thyroid and parathyroid disease

APC statement: Liothyronine in oncology

LIOTHYRONINEInjection 20microgramsMore rapid onset of action than levothyroxine
In hypothyroid coma though always check for adrenal sufficiency
BNF CODE – 6.2.2
ANTITHYROID DRUGSNOTES
CARBIMAZOLETablets 5mg, 20mgCSM WARNING
Observe for NEUTROPENIA & AGRANULOCYTOSIS
Monitor for signs of infection & blood cell count.
AQUEOUS IODINE (Lugol’s Solution)
Iodine 5%, potassium iodide 10%
Total Iodine 130mg/ml
 Visualisation in Surgery / Diagnostics
PROPYLTHIOURACILTablets 50mg
BNF CODE – 6.3.0
CORTICOSTEROIDSNOTES
GuidanceProvide Steroid treatment card, patient information leaflet and withdrawal/tapering guidance
FLUDROCORTISONETablets 100micrograms
BNF CODE – 6.3.2
GLUCOCORTICOID THERAPYNOTES
GuidancePREDNISOLONE 5mg is equivalent to the following
Betametasone 750mcg
Dexamethasone 750mcg
Hydrocortisone 20mg
Methylprednisolone 4mgWITHDRAWAL & GRADUAL TAPERING REQUIRED IN THE FOLLOWING:
1) repeated steroid courses over 3 weeks
2) short course within 1 year of stopping long term therapy
3) adrenal suppression
4) dose >40mg prednisolone equivalent
5) repeated evening doses
6) more than 3 weeks treatment course
PREDNISOLONETablets 1mg, 5mg, 25mg (restricted to oncology/haematology patients

Soluble tablets 5mg

Soluble tablets restricted to paediatrics only

Enteric coated tablets are non-formulary

BETAMETHASONEDispersible tablets 500micrograms

Injection 4mg

DEXAMETHASONETablets 500micrograms, 2mg

Injection 6.6mg/2ml (dexamethasone base)

 Dexamethasone memo March 2017
HYDROCORTISONETablets 10mg, 20mg

Injection (sodium phosphate) 100mg, (sodium succinate) 100mg

METHYLPREDNISOLONETablets 2mg

Injection (sodium succinate) 40mg, 500mg, 1g, 2g

Injection (acetate) 40mg, 80mg, 120mg (IM depot)

TRIAMCINOLONE ACETONIDEInjection 40mg in 1ml, 50mg in 5mlUsed for rheumatic disease and intra-articular injection.
No longer advised for IM route for allergic rhinitis/hayfever
BNF CODE – 6.4.0.1
SEX HORMONESNOTES
CSM – risk of breast cancer with HRT
CSM – risk of venous thromboembolism with HRT
CSM – risk of endometrial and ovarian cancer with HRT
CSM – risk of stroke and possibly coronary disease with HRT
 MHRA WARNING
SELECTIVE OESTROGEN RECEPTOR MODULATORNOTES
Raloxifene60mg TabletNICE TA160: Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women

NICE TA161: Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women

OESTROGENS & HRTNOTES
CSM – REASONS TO STOP HRT
severe chest pain, sudden breathlessness, severe calf pain or stomach painneurological effects (prolonged headache/epileptic seizure/loss of vision/marked numbness)hepatitis/jaundice, severe depression, BP>160/100
ESTRADIOL2mg Tablets

(ESTRADERM MX) 50 microgram Patches

EVOREL 25, 50 & 100 Patches

ETHINYLESTRADIOL Tablets
10micrograms, 50 micrograms & 1mg
ESTRADIOL + NORETHISTERONE PREPARATIONS:

EVOREL CONTI Patches

CLIMAGEST 2mg Tablets

KLIOVANCE Tablets

TRISEQUENS Tablets

FEMSEVEN 50 microgram in 24hr Patches
HORMONIN Tablets
PREMARIN 625 microgram Tablets
PREMIQUE Tablets
TIBOLONE 2.5 mg Tablets
BNF CODE – 6.4.1.2
PROGESTOGENSNOTES
MEDROXYPROGESTERONETablets 5mg, 10mg
NORETHISTERONETablets 1mg, 5mg
PROGESTERONEPessaries 200mg, 400mg

Injection 50mg in 1ml, 100mg in 2ml

CYCLO-PROGYNOVA 2 mg Tablets
PREMPAK-C 0.625 Tablets
PREMPAK-C 1.25 Tablets
BNF CODE – 6.4.2
MALE SEX HORMONES AND ANTAGONISTS (TESTOSTERONE)NOTES
TESTOSTERONETestosterone Decanoate Injection (Sustanon 250)

Undecanoate capsules 40mg

2% gel 10mg/application (Tostran)

Implant 100mg, 200mg

MESTEROLONE 25 mg Tablets
MALE SEX HORMONES AND ANTAGONISTSNOTES
DUTASTERIDE Capsules 500micrograms2nd  line 5-alpha-reductase inhibitor for BPH
FINASTERIDETablets 5mg1st  line 5-alpha-reductase inhibitor for BPH

PCN statement: finasteride male pattern baldness

BNF CODE – 6.5.1
HYPOTHALAMIC AND ANTERIOR PITUITARY HORMONESNOTES
CLOMIFENETablets 50mg
ANTERIOR PITUITARY HORMONESNOTES
TETRACOSACTIDEInjection 250micrograms in 1ml

Injection (Depot) 1mg in 1ml

GONADOTROPHINS      NOTES

NICE Guidance on use of Fertility Drugs

CHORIONIC GONADOTROPHIN(CHORAGON) 5000 units Injection

(BREVACTID) 1500 units vials

Specialist prescribing only

Induction of spermatogenenis in men with hypogonadism who desire fertility when Pregnyl is unavailable.

Endocrine testing: 3 week HCG test

Brevactid is unlicensed product. To prescribe when other products are unavailable.

Note: Pregnyl discontinued.

MENOTROPHIN (MERIONAL) 75 units Injection
MENOTROPIN (MENOPUR) 75 units Injection
GROWTH HORMONESNOTES
SOMATROPIN Injection 12mg (36 units) (Genotropin) Refill Cartridge
SOMATROPIN Injection 15mg (45 units) (Norditropin) SimpleXx Refill Cartridge
SOMATROPIN MiniQuick Injection 0.4mg (1.2 units) (Genotropin) Syringe
SOMATROPIN MiniQuick Injection 1.2mg (3.6 units) (Genotropin) Syringe
Growth Hormone Shared Care Guidance
HYPOTHALAMIC HORMONESNOTES
PROTIRELIN 200 micrograms in 2ml Injection
BNF CODE – 6.5.2
POSTERIOR PITUITARY HORMONES AND ANTAGONISTSNOTES
ARGIPRESSINInjection 20 units in 1mlRESTRICTED : ITU CONSULTANT ONLY (Unlicensed Use)   “For critically ill patients, within the ITU, with profound hypotension due to peripheral vasodilatation, eg septic shock/ severe infection or inflammation, in association with reduced responsiveness and effectiveness of usual catecholamine vasopressor therapy”

Approved off-licence use – reducing blood loss during myomectomy. Restricted to Obs & Gynae Consultants only, Screening checklist must be completed and sent to pharmacy with prescription

DESMOPRESSINTablets 100micrograms, 200 micrograms

Nasal spray 10 micrograms

Intranasal solution 100micrograms/ml

Injection 4 micrograms in 1ml

Safety Alert – Risk of severe harm or death when desmopressin is witheld or omitted in patients with cranial diabetes insipidus

 

APC Policy Statement Desmopressin for noctural polyuria

TERLIPRESSINInjection 1mg Terlipressin stock memo
ANTIDIURETIC HORMONE ANTAGONISTSNOTES
DEMECLOCYCLINECapsules 150mgUsed in treatment of hyponatraemia resulting from SIADH
MENOTROPHIN (MENOGON) 75 units Injection
MENOTROPHIN (MERIONAL) 75 units Injection
MENOTROPIN (MENOPUR) 75 units Injection
TOLVAPTAN (JINARC)Tablets 15mg, 30mg, 60mg, 90mgNICE Guidance Tolvaptan for treating autosomal dominant polycystic kidney disease [TA 358]
BNF CODE – 6.6.1
CALCITONIN AND SALCATONINNOTES
CALCITONIN (Salmon)Injection 100 units in 1ml, 400 units in 2ml
TERIPARATIDEInjection 250micrograms/mlNICE TA161: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women

RESTRICTED USE
Consultant RHEUMATOLOGIST Only

BNF CODE – 6.6.2
BISPHOSPHONATESPCN Osteoporosis Treatment Pathway for Adults Algorithm 1

NICE TA464: Bisphosphonates for treating osteoporosis

 

NICE TA160: Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women

NICE TA161: Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women

ALENDRONATE SODIUMTablets 10mg (daily)

Tablets 70mg (weekly)

Solution 70mg in 100ml

Joint 1st line agent
(RISEDRONATE is also 1st line)Solution suitable for patients with swallowing difficultiesPCN Policy Statement – Alendronate solution
IBANDRONIC ACIDTablets 150mg

Injection 3mg in 3ml

 

SMC Guidance RESTRICTED USE Consultant RHEUMATOLOGIST/ CARE of ELDERLY Only.
RISEDRONATE SODIUMTablets 5mg (daily)

Tablets 30mg , 35mg (weekly)

Joint 1st line agent (ALENDRONATE is also 1st line)

30mg tablet for Pagets disease of bone

SODIUM CLODRONATECapsules 400mg, Tablets 520mg
PAMIDRONATE DISODIUMInjection 5mg in 5ml
ZOLEDRONIC ACID (ZOMETA)Injection 4mg in 5mlRESTRICTED USE
In malignancy & multiple myeloma patients only
SWISH Ca Network Approved
ZOLEDRONIC ACID  (ACLASTA)Injection 50micrograms/mlRESTRICTED USE
Rheumatology & Orthogeriatrics
Guidelines
DENOSUMAB  (PROLIA)Pre-filled syringe 60mg/mlRESTRICTED USE Rheumatology & Orthogeriatrics
NICE TAG Denosumab
SASH_CCG DENOSUMAB [Green]
SASH_CCG Denosumab Rx Information
DENOSUMAB (XGEVA)Vial 120mgRESTRICTED USE
For solid tumour patients with bone metastases
NOT approved for patients with prostate cancer
SWISH Ca Network Approval NICE TA 265
BNF CODE – 6.7.1
BROMOCRIPTINE & DOPAMINERGICSNOTES
BROMOCRIPTINE 2.5 mg TabletsTablets 2.5mg
CABERGOLINE (DOSTINEX) 500 microgram TabletsTablets 500 micrograms
QUINAGOLIDEStarter pack tablets, 75 micrograms
BNF CODE – 6.7.2
DRUGS AFFECTING GONADOTROPHINSNOTES
DANAZOLCapsules 200mg
GONADORELIN ANALOGUESNOTES
GuidanceGonadorelin analogues used in treatment of endometriosis, precocious puberty, infertility, breast cancer and prostate cancer.
BUSERELIN 150 microgram Nasal Spray  (Suprecur) BUSERELIN 1mg in 1ml Injection
GOSERELINZoladex 3.6mg implantS/C Injection every 4 weeks
LEUPRORELIN ACETATE 3.75 mg Injection (Prostap SR)Prostap SR 3.75mgS/C or IM  injection every 4 weeks
NAFARELIN 200 microgram Nasal Spray (Synarel)
TRIPTORELIN 3.75 mg Injection Injection (Gonapeptyl Depot)S/C or IM injection : dose dependant on clinical indication
BNF CODE – 6.7.3
BREAST PAIN (MASTALGIA)NOTES
METYRAPONECapsules 250mg

 

1. Gastro-Intestinal System | 2. Cardiovascular System | 3. Respiratory System | 4. Central Nervous System | 5. Antimicrobials | 6. Endocrine System | 7. Obstetrics, Gynaecology & Urology | 8. Malignant Disease & Immunosuppression | 9. Nutrition & Blood | 10. Musculoskelatal & Joint Diseases | 11. Opthalmology | 12. Ear, Nose & Oropharynx | 13. Dermatology | 14. Immunology & Vaccines | 15. Anaesthetics |  GP Centre Home