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Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:

Endocrine-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Endocrine-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

 Details...
06.02.01  Expand sub section  Thyroid hormones
Levothyroxine
(Thyroxine,Tablet)
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Formulary
traffic lightGreen
  • 12.5 micrograms, 25 micrograms, 50 micrograms, 75 micrograms, 100 micrograms tablets
 
 
Liothyronine sodium ( Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 20 micrograms
  • For emergency treatment of hypothyroid coma, OR in patients exhibiting signs and symptoms of hypothyroidism following failure to administer/absorb usual oral replacement therapy (typically after 5-7 days).
  • Please note this this a high cost medicine

 

 
 
Liothyronine sodium ( Tablet)
View adult BNF View SPC online
Formulary
traffic lightAmber with Shared Care
  • Prescribers in primary care should not initiate liothyronine for any new patient
  • Please note - only the 20 microgram strength is on formulary. For lower doses the tablet can be dispersed in water. See SPC for details.
  • Liothyronine is non formulary for monotherapy, it should be used with levothyroxine (T4).
  • Please note this is a high cost medicine
  • The British Thyroid Association (BTA) advise that a small proportion of patients treated with levothyroxine continue to suffer with symptoms despite adequate biochemical correction.
  • In these circumstances, where levothyroxine has failed and in line with BTA guidance, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of at least 3 months duration of liothyronine.
  • Liothyronine is used for patients with thyroid cancer, in preparation for radioiodine ablation, iodine scanning, or stimulated thyroglobulin test. In these situations it is appropriate for patients to obtain their prescriptions from the centre undertaking the treatment and not be routinely obtained from primary care prescribers.
 
Link  BSW Shared Care Agreement Liothyronine (T3) for the combination treatment (T3 + Levothyroxine (T4)) of Hypothyroidism in a selected cohort of adults
Link  Items which should not routinely be prescribed in primary care ; guidance for CCGs
 
 ....
 Non Formulary Items
Armour thyroid

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Non Formulary
 
  
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
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Link to adult BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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