Formulary


	NHS Bath and North East Somerset, Swindon and Wiltshire CCG 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...

06.04.01.01

Oestrogens and HRT

BSW HRT Formulary Treatment options

Sep 2019 - Prescribing Advice - New HRT Risk Data

Combined continuous HRT
(Evorel® Conti)
(patch)

Formulary

Patches 50 micrograms estradiol 170 micrograms norethisterone
Change Twice a week

Combined continuous HRT
(Femoston Conti)
( Tablet)

Formulary

1mg estradiol + 5mg dydrogesterone
0.5mg estradiol + 2.5mg dydrogesterone (low dose)

Combined continuous HRT (Kliofem)
(Tablet)

Formulary

2mg estradiol and 1mg norethisterone
1 prescription charge.

Combined continuous HRT (Kliovance)
( Tablet)

Formulary

estradiol 1mg and norethisterone acetate 500micrograms

Combined continuous HRT
(Premique low dose)
( Tablet)

Formulary

300 micrograms conj. oestrogens and 1.5mg medroxyprogesterone acetate

Combined cyclical HRT
(Elleste-Duet®)
(Tablet)

Formulary

Tablets estradiol (1mg, 2mg) with 1mg norethisterone acetate
2 prescription charges

Combined cyclical HRT
(Evorel® Sequi)
(Patch)

Formulary

Patches 50 micrograms estradiol and 170 micrograms norethisterone acetate
Change patch Twice a week

Combined cyclical HRT (Femoston®)
(Tablet)

Formulary

Tablets (1mg or 2mg) estradiol with 10mg dydrogesterone

Oestrogen only HRT (Elleste-Solo®)
( Tablet)

Formulary

estradiol (1mg, 2mg)
1 prescription charge

Oestrogen only HRT (Estradot)
(Patch)

Formulary

estradiol (25, 37.5, 50, 75, 100 micrograms)
Change twice a week.

Oestrogen only HRT (Evorel)
( Patch)

Formulary

estradiol (25 micrograms, 50 micrograms, 75 micrograms, 100 micrograms)
Change twice a week.

Oestrogen only HRT (Oestrogel)
( Gel)

Formulary

0.06% oestradiol gel
0.75mg estradiol per measure, 2 measures=standard regime

Oestrogen only HRT (Premarin)
(Tablet)

Formulary

conjugated oestrogens (300 micrograms, 625 micrograms, 1.25 milligram)
1 prescription charge

Oestrogens for HRT
(Elleste-Duet Conti®)
(Tablet)

Formulary

2mg estradiol and 1mg norethisterone
1 prescription charge.

Oestrogens for HRT (Indivina)
(Tablet)

Formulary

Estradiol valerate 1mg /Medroxyprogesterone 2.5mg
Estradiol valerate 1mg /Medroxyprogesterone 5mg

Tibolone (Livial^®)
(Tablet)

Formulary

2.5mg

Oestrogens for HRT
(Progynova^®)
(Tablet)

Formulary

RUH only Specialist use fertility treatment (not HRT)
Not on formuary in Salisbury or Swindon.
1mg or 2mg estradiol valerate

MHRA Drug Safety Update (Sept 2019): Hormone replacement therapy (HRT): further information on the known increased risk of breast cancer with HRT and its persistence after stopping

NICE NG23: guidance on menopause

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Ethinylestradiol

Ethinylestradiol
(Oral)

Formulary

Bath
Swindon and Salisbury
Tablets 10 micrograms, 50 micrograms, 1mg.
2 microgram strength is an unlicensed special.
Licensed for short term use for short term treatment of oestrogen deficiency, female hypogonadism and menstrual disorders.
Also used for treatment of gender dysphoria

Note: Ethinylestradiol tablets are very expensive consider using estradiol where clinically appropriate as a more cost effective option.

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Raloxifene

Raloxifene Hydrochloride
(Tablet)

Formulary

60mg
Raloxifene is licensed for the treatment and prevention of postmenopausal osteoporosis; unlike HRT therapy, raloxifene does not reduce menopausal vasomotor symptoms.
NICE Guidance (TA161) recommends Raloxifene as an alternative treatment option in osteoporosis, under the certain circumstances.

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

06.04.01.01

Oestrogen only tablets

....

Non Formulary Items

Oestrogens for HRT
(Cyclo-Progynova^®)
(Tablet)

Non Formulary

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	High Cost Drug Approval System

Traffic Light Status Information

Status	Description
	RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.
	Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.
	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.
	These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.
	Suitable for patient to be directed to buy themselves
	Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.
	(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.
	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.