• For use in pregnant women with either gestational diabetes or pre-existing diabetes, after other insulins have been tried and failed to reach post-prandial glucose targets
• As per Effective Shared Care Agreement (ESCA)

• Prescribe by brand as recommended by MHRA.
  
• Substitution and automatic switching from Lantus® to Abasaglar®CANNOT BE UNDERTAKEN.

Prescribe by brand

• Reconsidered and approved in April 2017
• Specialist initiation.
• Supported by RICaD
• For patients who require more than 80 units of insulin glargine per day and who are troubled by nocturnal hypos. Transfer to Primary Care should not happen until specialists can demonstrate reduction in nocturnal hypos (e.g. after 3-4 months).

• First line glargine for new patients initiated on insulin glargine 100 units/mL.

• Prescribe by brand

• To avoid the use of an insulin pump in patients with Type 1 diabetes who have nocturnal/severe hypoglycaemia as defined in NICE TA 151 OR recurrent DKA despite good compliance with current insulin regime
• Specialist initiation
• Supported by a RICaD, see link below.

• Specialist use only
• For the treatment of patients with Type 2 diabetes who have nocturnal / severe hypoglycaemia or those with recurrent hypoglycaemic episodes requiring hospital admission

• Use in pregnancy (as per NICE) for patients who do not want to move to insulin but are not responding to metformin

In line with NICE

See Type 2 diabetes DMMAG Guideline for the choice of oral and non-insulin antihyperglycaemic agents in adults

SLGT2 inhibitors are not to be used in primary care for type 1 diabetes until further local guidance becomes available

In line with NICE

See Type 2 diabetes DMMAG Guideline for the choice of oral and non-insulin antihyperglycaemic agents in adults

SLGT2 inhibitors are not to be used in primary care for type 1 diabetes until further local guidance becomes available

 for treating Type 2 diabetes in line with NICE 

 Specialist centres only for treating Type 1 diabetes as per NICE TA 597: Dapagliflozin with insulin for treating type 1 diabetes

In line with NICE

See Type 2 diabetes DMMAG Guideline for the choice of oral and non-insulin antihyperglycaemic agents in adults

SLGT2 inhibitors are not to be used in primary care for type 1 diabetes until further local guidance becomes available

In line with NICE

See Type 2 diabetes DMMAG Guideline for the choice of oral and non-insulin antihyperglycaemic agents in adults

SLGT2 inhibitors are not to be used in primary care for type 1 diabetes until further local guidance becomes available

Sotagliflozin is not yet available in the NHS, but the company anticipates that it will be available to the NHS in England and Wales within 12 months of guidance publication.

• NOT for monotherapy

Caution - retinopathy. Do not use in patients with pre-proliferative/proliferative retinopathy (R2/R3 grade) or maculopathy (M1) or who are undergoing or awaiting eye laser or intravitreal treatments. Ensure all patients are up-to-date with their retinopathy screening programme prior to initiation of semaglutide, and that they attend their annual screening whilst on treatment.

• Potassium iodide tablets 65mg
• Potassium iodate 85mg
• Aqueous Iodine Oral solution
• Also known as Lugol's Iodine

• Estradot® patch 

• 2nd line to Evorel Sequi®

• Progynova® 1mg and 2mg tablets

• If a 40mcg or 80mcg strength required

• ££££

• Specialist recommendation

• Fertility use only

• Fertility use only

• Zumenon® 1mg and 2mg tablets
• Alternative if Elleste Solo® is not available 

• For induction of puberty in female patients who cannot tolerate or are allergic to first-line patches.
•  2 microgram- unlicensed special

•  Specialist recommendation - 10 microgram ££

In line with NICE

• Generic 
• Evirex® £££
• Evista® £££
• Ostiral® £££
• Razylan® £££

•  Generic tablets 
•  Utovlan®
• Noriday® - if used in HRT - Specialist initiation

  Recurrent miscarriage (off label use)

  Fertility (off label use)

• Supported by a RICaD

• Testim (Discontinued)
• Testavan 
• Testogel
• Tostran
• use in women with low libido approved by APC (unlicensed). Specialist to initiate and issue first supply.

• When finasteride has failed or is contraindicated/not tolerated

• for Hyperandrogenism in women (unlicensed)
  
  
• Black listed in NHS primary care

• For ovulation induction
• On specialist recommendation
• Generic tablets

• in the treatment of hyponatraemia resulting from inappropriate secretion of antidiuretic hormone. UNLICENSED

• The need for continued bisphosphonate treatment should be re-evaluated periodically particularly after 5 or more years of use

• £££
• Third line option in individuals who have not tolerated first line alendronate tablets and second line risedronate tablets and in whom a bone-sparing agent is still considered clinically necessary.
• The need for continued bisphosphonate treatment should be re-evaluated periodically particularly after 5 or more years of use

• For skeletal events in metastatic breast cancer.
• Supported by an ESCA, see link below.

• For the management of osteolytic lesions, bone pain and hypercalcaemia associated with multiple myeloma or breast cancer.
• Supported by an ESCA, see link below.

• Use in postmenopausal osteoporosis is supported by an ESCA, see link below.

• For hereditary angioedema (off label use)

• For endometriosis or breast cancer
• Specialist initiation

• For endometrosis or breast cancer
• Specialist initiation

• For endometriosis
• Specialist initiation