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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:

This chapter is mostly updated. The section still outstanding is 6.4.1.1 (oestrogens and HRT). 

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06.01.01.02  Expand sub section  Intermediate- and long-acting insulins
Insulin detemir (Levemir®)
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Formulary
Green
 
   
Insulin glargine 100 units/mL biosimilar (Abasaglar®)
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Formulary
Green
  • Prescribe by brand as recommended by MHRA.

  • First line for new patients initiated on insulin glargine 100 units/mL
  • Substitution and automatic switching from Lantus® to Abasaglar®CANNOT BE UNDERTAKEN.  
  • Link  Answers to commonly asked questions about biosimilar versions of insulin glargine
    Link  Risk Assessment- High Strength Insulins/ Biosimilars/ Fixed Combination
       
    Insulin glargine 100 units/mL (Lantus®)
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    Formulary
    Green
    £

  • Prescribe by brand 
  •    
    Insulin glargine 300 units/mL (Toujeo®)
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    Formulary
    Amber
    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).  
  • Link  Risk Assessment- High Strength Insulins/ Biosimilars/ Fixed Combination
       
    Isophane Insulin (Humulin® I)
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    Formulary
    Green
     
       
    Isophane Insulin (Insulatard®)
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    Formulary
    Green
     
       
    Isophane Insulin (Insuman® Basal)
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    Formulary
    Green
     
       
    Insulin degludec 100 units/mL (Tresiba®)
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    Formulary
    Amber
    • 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.
     
    Link  RICaD: Insulin degludec
       
    Insulin degludec 100 units/mL (Tresiba®)
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    Formulary
    Red
    • 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

     

     
       
    06.01.01.02  Expand sub section  Biphasic insulins
    Biphasic Insulin Aspart (NovoMix® 30)
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    Formulary
    Green
     
       
    Biphasic Insulin Lispro (Humalog® Mix)
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    Formulary
    Green
  • Humalog Mix25
  • Humalog Mix50 
  •    
    Biphasic Isophane Insulin (Humulin® M3)
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    Formulary
    Green
     
       
    Biphasic Isophane Insulin (Insuman® Comb)
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    Formulary
    Green
  • Insuman Comb 15
  • Insuman Comb 25
  • Insuman Comb 50 
  •    
     ....
     Non Formulary Items
    Biphasic Isophane Insulin  (Hypurin® Porcine 30/70 Mix)

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    Non Formulary
    Black
  • For existing patients only
  •  
    Insulin degludec 200 units/mL  (Tresiba®)

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    Non Formulary
     
    Insulin degludec and liraglutide  (Xultophy®)

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    Non Formulary
     
    Insulin Zinc suspension  (Hypurin®Bovine Lente)

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    Non Formulary
    Black
  • For existing patients only
  •  
    Isophane Insulin  (Hypurin® Bovine Isophane)

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    Non Formulary
    Black
  • For existing patients only
  •  
    Isophane Insulin  (Hypurin® Porcine Isophane)

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    Non Formulary
    Black
  • For existing patients only
  •  
    Isophane Insulin  (Pork Insulatard®)

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    Non Formulary
     
    Protamine Zinc Insulin  (Hypurin® Bovine Protamine Zinc)

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    Non Formulary
    Black
  • For existing patients only
  •  
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Green

    Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications.  

    Amber

    Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.

    Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements.   

    Red

    Medicines for initiation and maintenance prescribing by Specialists only  

    Black

    Non-formulary medicines- medicines not recommended for routine primary care prescribing.  

    Grey

    Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information.  

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