Endocrine system

6.1.1.1 short-acting insulins

First line: Insulin aspart (NovoRapid®) human soluble insulin (Actrapid^®)
Alternatives: human soluble insulin (Humulin S®),
Second line options: insulin glulisine (Apidra®), insulin lispro (Humalog®)

6.1.1.2 intermediate and long acting insulins

Human long-acting insulins

First line: insulin glargine (Lantus®)
Alternative: insulin detemir (Levemir®)

Human isophane insulins

options: Human Insulatard, Humulin I®

Human biphasic insulins

First line options: Biphasic insulin aspart (Humulin M3®, NovoMix 30®)
Second line options: Biphasic insulin lispro (Humalog Mix 25®, Humalog Mix 50®)

Type II diabetes human insulin guidelines

6.1.2.1 Sulphonylureas

First line: gliclazide
Second line options: glimepiride, glipizide, gliclazide MR

For specialist use only: tolbutamide

6.1.2.2 Biguanides

First line: metformin
Second line: metformin m/r

6.1.2.3 Other antidiabetic drugs

First line: pioglitazone, sitagliptin, saxagliptin
Second line: acarbose, vildagliptin

For specialist initiation only: exenatide (including m/r), liraglutide, lixisenatide

shared care guideline for exenatide, including m/r and liraglutide

shared care guideline to be updated and categorisation to be reviewed

6.1.4 Treatment of hypoglycaemia

First line: GlucoGel®, Dextrogel®, Glucagen Hypokit®

For hospital initiation only: diazoxide

6.1.6 Diagnosis and monitoring devices for diabetes mellitus

Blood glucose monitoring options: Aviva®, Contour®, One Touch®, Optimum Plus®.
Urinalysis options: Clinistix®, Ketostix®
Glucose tolerance test: Polycal liquid®

6.2.1 Thyroid hormones

First line: levothyroxine sodium

For hospital use only: liothyronine sodium

6.2.2 Antithyroid drugs

First line: carbimazole

For use in pregnancy: propylthiouracil

For hospital use only: radioactive iodine-131 capsules, aqueous iodine oral solution (Lugol's solution®)

6.3.1 Replacement therapy

fludrocortisone

6.3.2 Glucocorticoid therapy

First line: prednisolone
Second line: betamethasone, hydrocortisone, methylprednisolone, prednisolone e/c, triamcinolone
For specific indications only: dexamethasone

6.4.1.1 Oestrogens and HRT
Conjugated oestrogens with progestogen

First line: Prempak-C®, Premique®

Estradiol with progestogen:

First line: Elleste-Duet®, Evorel Conti®, Femapak®, Femseven Conti®, Kliofem®, Kliovance®
Second line: Climagest®, Elleste-Duet Conti®, Evorel Sequi®, Femoston®, FemSeven Sequi®

Conjugated oestrogens only:

First line: Elleste-Solo®, Evorel®, FemSeven®, Oestrogel®
Second line: Elleste Solo MX®, Climaval®, Premarin®

Short-term treatment of oestrogen deficiency

tibolone

Treatment and prevention of postmenopausal osteoporosis

raloxifene

6.4.1.2 Progestogens

First line options: medroxyprogesterone acetate, norethisterone, progesterone

For hopsital use only: ulipristal acetate (Esmya®)

6.4.2 Male sex hormones and antagonists

Testosterone and esters:

First line: testosterone gel

For hospital initiation only: testosterone implant, testosterone injection im
For hypoactive sexual desire disorder associated with surgically induced menopause: testosterone patch (Intrinsa®)

Anti-androgens:

First line: cyproterone, finasteride
Second line: dutasteride

6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens
Anti-oestrogens:

clomifene

Corticotrophins:

For hospital use only: tetracosactide

Gonadotrophins:

For hospital use only: chorionic gonadotrophin, follitropin alfa and beta, urofollitrophin

Growth hormone:

For hospital use only: somatropin

Commissioning statement on the use of growth hormone in children and adults

Growth hormone receptor antagonists:

For hospital use only: pegvisomant

Hypothalmic hormones:

For hospital use only: gonadorelin

6.5.2 Posterior pituitary hormones and antagonists

For hospital initiation only: desmopressin

For hospital use only: terlipressin, vasopressin

Antidiuretic hormone antagonists:

First line: demeclocycline

6.6.1 Calcitonin and parathyroid hormones

calcitonin (salmon) for prevention of acute bone loss due to sudden immobility

For hospital use only: calcitonin (salmon) for hypercalcaemia of malignancy, parathyroid hormone, teriparatide

6.6.2 Bisphosphonates and other drugs affecting bone metabolism

For osteoporosis

First line: alendronic acid
Second line: risedronate, ibandronic acid, disodium etidronate
Third line: strontium ranelate, denosumab

For hospital initiation: IV zoledronic acid

Reduction of bone damage in bone metastases in breast cancer

First line: oral ibandronate

Second line: denosumab

For Paget's disease

Risedronate

Other indications

For hospital use only according to licensed indication: disodium pamidronate, sodium clodronate

6.7.1 Bromocriptine and other dopaminergic drugs

First line: bromocriptine

Second line: cabergoline

6.7.2 Drugs affecting gonadotrophins

First line: danazol

Gonadorelin analogues:

First line options in accordance with licence: goserelin, leuprorelin acetate, triptorelin

For hospital use only: buserelin, nafarelin

6.7.3 Metyrapone and trilostane

Pan-Dorset Formulary