6. Drugs used in the treatment of disorders of the Endocrine System

6.1 Drugs used in diabetes

6.1.1

6.1.1.1 Short-acting insulins Soluble - Human Actrapid® - Human Velosulin® - Humulin S® - Hypurin Neutral® - Insuman Rapid® - Pork Actrapid® Insulin aspart - NovoRapid® Insulin lispro - Humalog®

6.1.1.2 Intermediate- and long-acting insulins insulin detemir (initiated by Diabetologists only) insulin glargine (initiated by Diabetologists only ) insulin glulisine (initiated by Diabetologists only )

Isophane insulin - Human Insulatard® - Humulin I® - Hypurin Isophane® - Insuman Basal® - Pork Insulatard® Biphasic insulin aspart NovoMix 30® Biphasic insulin lispro Humalog® Mix25 Humalog® Mix50 Biphasic isophane insulin - Human Mixtard 10® - Human Mixtard 20® - Human Mixtard 30® - Human Mixtard 40® - Human Mixtard 50® - Humulin M3® - Insuman Comb® 6.1.2 Oral antidiabetic drugs - Pork Mixtard 30®

Avandamet® (rosiglitazone/) gliclazide glipizide metformin metformin MR (Diabetologists and Dr Staniland only) nateglinide pioglitazone 6.1.4 Treatment of hypoglycaemia rosiglitazone vildagliptin (only in line with NICE recommendations)

6.2 and antithyroid drugs

6.2.1 Thyroid levothyroxine sodium/thyroxine sodium

6.2.2

6.3 Corticosteroids 6.3.1 Replacement therapy fludrocortisone 6.3.2 therapy betametasone hydrocortisone

6.4 Sex Hormones 6.4.1 Female sex hormones 6.4.1.1 and HRT - with progestogen Femoston Conti® tablets ( continuous ) Femoston® tablets - estradiol only estradiol implants estradiol transdermal patches ( FemSeven® ) estradiol vaginal ring ( Menoring® ) estradiol valerate (Elleste Solo® tablets) - ethinylestradiol raloxifene ( rheumatology and endocrinology only )

6.4.1.2 Progestogens dydrogesterone hydroxyprogesterone caproate medroxyprogesterone acetate norethisterone

6.4.2 Male sex hormones and antagonists ( urology only ) & esters ( includes intramuscular injection, implants , Nebido ® - e ndocrinology only) Miscellaneous ( endocrinology only - unlicenced)

6.5 Hypothalamic and pituitary hormones and anti-oestrogens

6.5.1 Hypothalamic and chorionic gonadotrophin (hcg) hormones and anti-oestrogens clomiphene citrate gonadorelin (lhrh) menotrophin (lh & fsh) protirelin (trh) somatropin (in accordance with NICE guidance ) - Follow restricted high cost drug procedure when prescribing somatropin tetracosactide urofollitropin (fsh)

6.5.2 hormones and antagonists terlipressin (Gastroenterology, A&E and EAU only ) (Gastroenterology only )

6.6 Drugs affecting bone metabolism

6.6.1 calcitonin salmon/salcatonin

6.6.2 (including once a week products ) disodium etidronate disodium pamidronate ibandronate IV ( Bonviva® ) (For use by consultant rheumatologists in the treatment of post-menopausal only) risedronate sodium (weekly risedronate is first line, except for male patients and patients with gastro-intestinal problems whereby alendronate should be considered first line) sodium clodronate (Rheumatology and Elderly Care consultants only in accordance with Trust Guidelines for the Prevention and Management of Osteoporosis ) (Dr T O'Neill only ) - Follow restricted high cost drug procedure when prescribing teriparatide tiludronic acid (Rheumatology only ) (licensed indications only - for use by Urology and Haematology [Myeloma IX trial] directorates only)

6.7 Other endocrine drugs

6.7.1 Bromocriptine & other - bromocriptine stimulants cabergoline ( obs & gynae only) 6.7.2 Drugs affecting gonadotrophins danazol Gonadorelin analogues buserelin goserelin (consultant only ) leuprorelin (Prostap® SR) (Obstetric and Gynaecology directorate only - a shared care protocol is required if care is to be continued in primary care )

6.7.3 and trilostane metyrapone