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Nottinghamshire Area Prescribing Committee
Joint Formulary
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 Formulary Chapter 6: Endocrine system - Full Chapter
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06.01.01.02  Expand sub section  Intermediate- and long-acting insulins
Isophane Insulin (Humulin I)
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Formulary
Green
10mL vial, 3mL cartridge, 3mL prefilled pen (KwikPen) 
   
Isophane Insulin (Insulatard)
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Formulary
Green

10mL vial, 3mL cartridge, InnoLet.

NB: please note that the Innolet presentation should not be used in paediatric patients - using cartridges is recommended

 
   
Isophane Insulin (Insuman Basal)
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Formulary
Green

5ml vial,

3mL cartridge for Allstar® Pro (previously ClikSTAR® which has been discontinued)

3ml disposable pen - Solostar®

 
   
Insulin Glargine biosimilar
(Semglee)
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Formulary
Amber 2

3mL prefilled pen

  • First line insulin glargine product for new patients being initiated on insulin glargine or those requiring a medication change.
  • Amber 2 - On recommendation from specialist clinic only.
  • Semglee®, Abasaglar® and Lantus® should not be used interchangeably. Ensure all prescriptions and communications specify brand.
 
   
Insulin Glargine (Lantus)
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Formulary
Amber 2

10mL vial, 3mL cartridge for Allstar® Pro, 3mL disposable prefilled pen - Solostar®

  • The first line insulin glargine product for new patients is Semglee® (available as prefilled pen only).
  • Restricted for patients as per NICE guidance
  • Amber 2 - On recommendation from specialist clinic only
  • Semglee®, Abasaglar® and Lantus® should not be used interchangeably. Ensure all prescriptions and communications specify brand.
 
Link  Link to reviews
   
Insulin Glargine biosimilar
(Abasaglar)
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Formulary
Amber 2

3mL prefilled pen, 3mL refill cartridge.

  • Reserved for existing patients only.
  • Amber 2 - On recommendation from specialist clinic only
  • Semglee®, Abasaglar® and Lantus® should not be used interchangeably. Ensure all prescriptions and communications specify brand.
 
Link  Biosimilars- Notts APC guide
Link  Link to reviews
Link  NHSE publication. What is a Biosimilar medicine
Link  NICE KTT15: Biosimilar medicines
Link  UKMi Briefing - October 2015
   
Insulin Detemir (Levemir)
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Formulary
Amber 2

3mL cartridge, 3mL prefilled pen.

  • Restricted for patients as per NICE guidance
  • Amber 2 - On recommendation from specialist clinic only
 
Link  Link to reviews
   
Insulin degludec (Tresiba)
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Formulary
Amber 2

Note that there are two strengths of insulin degludec! See link to MHRA warning below. Caution should be exercised when prescribing and dispensing.

100 units / ml cartridges, 100 units / ml FlexTouch® prefilled pens.

  • Restricted Item Initiation only for patients with:
    • type 1 diabetes currently treated with insulin glargine with recurrent admissions for ketoacidosis treatment due to insulin omission OR with recurrent, particularly nocturnal, severe hypoglycaemia.
    • type 2 diabetes currently treated with insulin glargine where existing basal insulin is running out OR with poor compliance OR requiring flexibility of administration OR with recurrent, particularly nocturnal, severe hypoglycaemia.

200 units / ml FlexTouch® prefilled pens.

  • Restricted Item Initiation only for patients requiring high doses of insulin that cannot be delivered using the lower strength 
 
Link  MHRA safety alert on availability of 2 strengths
Link  Link to reviews
   
Insulin Glargine 300 units/ml (Toujeo)
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Restricted Drug Restricted
Amber 2
  • 300 units per ml (high strength)
  • Prescribe by brand name.
  • Available in two devices:
    • Solostar® disposable pen (1 unit increments and max dose 80units)
    • Doublestar® disposable pen (2 unit increments and max dose 160units)
  • Only for use in patients that would otherwise require insulin 500units/ml
    OR  As 2nd line basal insulin after insulin glargine 100units/ml (or comparable basal insulin) in patients with poorly controlled diabetes and at least one of the following:
      - requiring twice daily basal insulin (as once daily is insufficiently long acting)
      - lipohypertrophy
      - experiencing nocturnal hypoglycaemia
      - requiring carer administration once a day, where delays in administration are impacting on diabetes control
 
Link  Link to reviews
   
Isophane Insulin (Hypurin Bovine Isophane)
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Formulary
Green
10mL vial
  • Existing patients only
  • Discontinued 2017 - possible availability until 2018 
  •    
    Isophane Insulin (Hypurin Porcine Isophane)
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    Formulary
    Green
    10mL vial, 3ml cartridge
  • Existing patients only 
  •    
    Insulin Zinc suspension (HypurinBovine Lente)
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    Formulary
    Green
    10mL vial, 3ml cartridges.
  • Existing patients only.
  • Discontinued 2017 - possible availability until 2019 
  •    
    06.01.01.02  Expand sub section  Biphasic insulins
    Biphasic Isophane Insulin (Humulin M3)
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    First Choice
    Green
  • 10mL vial, 3mL cartridge, 3mL prefilled pen 
  • Biphasic Insulin Aspart (NovoMix 30)
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    Formulary
    Amber 2
  • 10mL vial, 3mL cartridge, 3mL prefilled pen 
  •    
    Biphasic Insulin Lispro (Humalog Mix)
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    Formulary
    Amber 2
  • Available as Mix25 and Mix50.
  • 3mL cartridge, 3mL prefilled pen (KwikPen), Vial (Mix25 only) 
  •    
    Biphasic Isophane Insulin (Insuman Comb)
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    Formulary
    Green
  • Available as Comb 15, Comb 25, and Comb 50
     
  •    
     ....
     Non Formulary Items
    Biphasic Isophane Insulin  (Hypurin Porcine 30/70 Mix)

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    Non Formulary
    Grey
    10ml vial
    3ml cartridge
     
    Biphasic Isophane Insulin  (Mixtard 30)

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    Non Formulary
    Grey
  • Discontinued from 31 December 2010
  • Mixtard 10, 20, 40 and 50 and Pork Mixtard 30 all discontinued prior to 2010.
  • Link  Notts County PCT letter to clinicians on Mixtard discontinuation
     
    Insulin degludec and liraglutide  (Xultophy)

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    Non Formulary
    Grey
  • Classified in APC Jan 2016
  • Link  Link to reviews
     
    Insulin degludec with insulin aspart  (DegludecPlus)

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    Non Formulary
    Grey
  • No formal submission
  •  
    Isophane Insulin  (Pork Insulatard)

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

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    Non Formulary
    Grey
  • Discontinued 2017 - possible availability until 2018
  •  
      
    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
    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

    Traffic Light Status Information

    Status Description

    Grey

    Grey / Non-Formulary: Medicines, which the Nottinghamshire APC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.
    Grey / Non-Formulary (undergoing assessment): Work is ongoing and will be reviewed at a future APC meeting.
    Grey / Non-Formulary (no formal assessment): APC has not formally reviewed this medicine or indication because it had never been requested for formulary inclusion. Often used for drugs new to market.
      

    Red

    Medicines which should normally be prescribed by specialists only. eg hospital only.
    For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.
      

    Amber 1

    Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol, once the patient has been stabilised.
    Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the Nottinghamshire APC.
      

    Amber 2

    Medicines suitable to be prescribed in primary care / general practice after specialist* recommendation or initiation.
    A supporting prescribing guideline may be requested which must have been agreed by the relevant secondary care trust DTCs and approved by the Nottinghamshire APC.
    *Specialist is defined by the APC as a clinician who has undertaken an appropriate formal qualification or recognised training programme within the described area of practice
      

    Amber 3

    Primary care/ non specialist may initiate as per APC guideline.
    The supporting prescribing guideline must have been agreed by the relevant secondary care trust D&TC(s) and approved by the Nottinghamshire APC.
      

    Green

    Medicines suitable for routine use within primary care.
    Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.   

    OTC

      

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