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6. Endocrine System

Clinical Guidelines from NICE related to endocrine disease can be found here

Actrapid (Soluble insulin)
BNF | BNFC | SPC

Vial - 10ml 

Humulin S (Soluble insulin)
BNF | BNFC | SPC

Vial - 10ml 

Cartridges for Autopen Classic or HumaPen

Novorapid (Aspart)
BNF | BNFC | SPC

10ml - Vial, Penfill cartridges, Prefilled Flexpen pen

Apidra (Glulisine)
BNF | BNFC | SPC

Vial - 10ml 

Cartridges for ClickSTAR & Autopen, Solostar prefilled pen

Humalog (Lispro)
BNF | BNFC | SPC

Vial - 10ml

Cartridges for Autopen classic or Humapen, KwickPen prefilled device

Lantus (Glargine)
BNF | BNFC | SPC

Vial - 10ml

Cartridges for ClickSTAR and Autopen 24, Solostar prefilled device

Levemir (Detemir)
BNF | BNFC | SPC

Cartridges for Novopen, Prefilled FlexPen device

Insulatard (Isophane)
BNF | BNFC | SPC

Vial - 10ml

Cartridges for Insulatard penfill, Insulatard Innolet prefilled device

Humulin I (Isophane)
BNF | BNFC | SPC

Vial - 10ml

Cartridges for Autopen Classic or HumaPen, Humulin I KwikPen prefilled device

Insulin Degludec (Recombinant human insulin analogue—long acting) (Tresiba®)
BNF | BNFC | SPC

5 × 3-mL Penfill® cartridges (for Novo Nordisk® devices) 100 units/mL,

5 × 3-mL FlexTouch® prefilled disposable injection devices (range 1– 80 units, allowing 1-unit dosage adjustment)

Also available as 200units / ml. NOT on formulary at this strength. For initiation by Consultant only for Type 1 diabetic patients who remain at significant risk of hypoglycaemia despite intensive insulin treatment

Gliclazide
BNF | BNFC | SPC

Tablets - 40mg, 80mg

MR Tablets - 30mg

Glimepiride
BNF | BNFC | SPC

Tablets - 1mg, 2mg, 3mg, 4mg

Glipizide
BNF | BNFC | SPC

Tablets - 5mg

Metformin
BNF | BNFC | SPC

Tablets - 500mg, 850mg

MR Tablets - 500mg, 750mg, 1G

Oral Solution - 500mg/5ml

Lixisenatide
BNF | BNFC | SPC

50 micrograms/mL, 10 micrograms/dose prefilled pen, 100 micrograms/mL, 20 micrograms/dose prefilled pen

Dulaglutide
BNF | BNFC | SPC

1.5 mg solution for injection in a pre-filled pen  

GLP-1 first line option is Lixisenatide, second line Dulaglutide. Liraglutide and Exenatide are approved by NICE and may be considered on an individual patient basis but are considered less cost effective than the other two agents.

Acarbose
BNF | BNFC | SPC

Tablets - 50mg

Pioglitazone
BNF | BNFC | SPC

Tablets - 15mg, 30mg

Repaglinide
BNF | BNFC | SPC

Tablets - 500 micrograms, 1mg

Alogliptin
BNF | BNFC | SPC

Tablets - 6.25mg, 12.5mg, 25mg

Empagliflozin
BNF | BNFC | SPC

Tablets - 10mg, 25mg

Approved by NICE as options for treating type 2 diabetes in adults for whom metformin is contraindicated or not tolerated, and when diet and exercise alone do not provide adequate glycaemic control, only if:

  • A dipeptidyl peptidase-4 (DPP-4) inhibitor would otherwise be prescribed
  • A sulfonylurea or pioglitazone is not appropriate.
Canagliflozin
BNF | BNFC | SPC

Tablets - 100mg

Approved by NICE as options for treating type 2 diabetes in adults for whom metformin is contraindicated or not tolerated, and when diet and exercise alone do not provide adequate glycaemic control, only if:

  • A dipeptidyl peptidase-4 (DPP-4) inhibitor would otherwise be prescribed
  • A sulfonylurea or pioglitazone is not appropriate.
Dapagliflozin
BNF | BNFC | SPC

Tablets - 5mg, 10mg

Approved by NICE as options for treating type 2 diabetes in adults for whom metformin is contraindicated or not tolerated, and when diet and exercise alone do not provide adequate glycaemic control, only if:

  • A dipeptidyl peptidase-4 (DPP-4) inhibitor would otherwise be prescribed
  • A sulfonylurea or pioglitazone is not appropriate.
Glucagon
BNF | BNFC | SPC

Injection - 1mg

Glucose Gel
BNF | BNFC | SPC
Levothyroxine
BNF | BNFC | SPC

Tablets - 25micrograms, 50micrograms, 100micrograms

Carbimazole
BNF | BNFC | SPC

Tablets - 5mg

BNF states: Neutropenia and agranulocytosis: Doctors are reminded of the importance of recognising bone marrow suppression induced by carbimazole and the need to stop treatment promptly.

Patient should be asked to report symptoms and signs suggestive of infection, especially sore throat.

A white blood cell count should be performed if there is any clinical evidence of infection.

Carbimazole should be stopped promptly if there is clinical or laboratory evidence of neutropenia.

Propylthiouracil
BNF | BNFC | SPC

Tablets - 50mg

Fludrocortisone Acetate
BNF | BNFC | SPC

Tablets - 100micrograms

Prednisolone
BNF | BNFC | SPC

Tablets - 1mg, 5mg, 25mg

Tablets soluble - 5mg

Oral solution - 1mg/1ml (Prednisolone Dompé)

There are no clinical benefits from prescribing prednisolone as enteric coated tablets. The risk of gastro-intestinal side-effects are no higher with plain tablets, especially if the patient takes the tablets with food.

Lowest cost formulation to be used when clinically appropriate

Hydrocortisone
BNF | BNFC | SPC

Tablets - 10mg, 20mg

Injection - 100mg

Betamethasone
BNF | BNFC | SPC

Tablets Soluble - 500microgram

Injection - 4mg

Dexamethasone
BNF | BNFC | SPC

Tablets Soluble - 500micrograms

Injection - 4mg

Triamcinolone
BNF | BNFC | SPC

Injection - 40mg/ml

Prempak-C
BNF | BNFC | SPC

Tablets - 0.625micrograms, 1.25mg

Premique Low Dose
BNF | BNFC | SPC

Tablets - 300micrograms oestrogen & 1.5mg medroxyporgesterone

Evorel Conti
BNF | BNFC | SPC

Patches - 50microgram/24hours estradiol & 170microgram/24hours norethisterone

 

Fem-Seven Conti
BNF | BNFC | SPC

Patches - 50microgram/24hours estradiol & 7microgram/24hours levonorgestrel 

Premarin
BNF | BNFC | SPC

Tablets - 300microgram, 600microgram, 1.25mg conjugated oestrogens

Climaval
BNF | BNFC | SPC

Tablets - 1mg, 2mg oestrodiol

Estradot
BNF | BNFC | SPC

Patches - 25micrograms/24hours, 50micrograms/24hours75micrograms/24hours, 100microgram/24hours estradiol

Tibolone
BNF | BNFC | SPC

Tibolone Tablets - 2.5mg

Short term treatment of symptoms

Medroxyprogesterone
BNF | BNFC | SPC

Tablets - 2.5mg, 5mg, 10mg

Norethisterone
BNF | BNFC | SPC

Tablets - 5mg

Cyproterone Acetate
BNF | BNFC | SPC

Tablets - 50mg, 100mg

Approved for use on the advice of a urologist

 

Testosterone undecanoate
BNF | BNFC | SPC

1gram in 4ml oily injection 

40mg - capsules 

Testosterone
BNF | BNFC | SPC

50mg in 5gram (1%) gel - For use on advice from endocrinologists

50mg in 5ml (1%) sachets - For use on advice of endocrinologist

10mg in 0.5ml (2%)/metered dose gel pump - For use on advice from endocrinologist

 

 

Testosterone (1)
BNF | BNFC | SPC

1ml injection 

Sustanon® 250 1ml injection contains testosterone propionate 30mg, testosterone phenylpropionate 60mg, testosterone isocaproate 60mg and testosterone decanoate 100mg

Desmopressin
BNF | BNFC | SPC

Tablets - 100micrograms, 200micrograms

Nasal Spray - 10micrograms/metered spray

Tolvaptan
BNF | BNFC | SPC

Tablets - 15mg, 30mg

Consultant initiation only. Recommended by NICE as an option in treatment of autosomal dominant polycystic kidney disease within specified criteria

Alendronic Acid
BNF | BNFC | SPC

Tablets - 70mg

Once a week dose

Risedronate
BNF | BNFC | SPC

Tablets - 35mg

Once a week dose

Denosumab
BNF | BNFC | SPC

Injection - 60mg/ml

Consultant initiation only. Recommended by NICE as an option in treatment of secondary or primary prevention of osteoporotic fragility fractures in post-menopuasal women only when unable to tolerate, comply with administration instructions or contraindicated to at least two bisphosphonates

Strontium ranelate
BNF | BNFC | SPC

Powder sachet - 2g

Contraindicated in current or previous VTE, IHD, PAD, cerebrovascular disease, uncontrolled hypertension, temporary or prolonged immobilisation. Severe allergic reactions including DRESS have been reported. Patients must discontinue and treatment should not be restarted

Bromocriptine
BNF | BNFC | SPC

Tablets - 1mg, 2.5mg

Specialist initiation only

Cabergoline
BNF | BNFC | SPC

Tablets - 500 microgram

Specialist initiation only

Danazol
BNF | BNFC | SPC

Capsules - 100mg, 200mg

Specialist initiation only

Gestrinone
BNF | BNFC | SPC

Capsules - 2.5mg

Specialist initiation only

Goserelin Injection – see section 8.3.4.2
BNF | BNFC | SPC

Specialist initiation only

Nafarelin
BNF | BNFC | SPC

Nasal spray - 200 microgram

Specialist initiation only

Ulipristal Acetate (Esmya)
BNF | BNFC | SPC

Tablets - 5mg

Specialist initiation only