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Nottinghamshire Area Prescribing Committee
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 Formulary Chapter 6: Endocrine system - Full Chapter
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06.04.01.01  Expand sub section  Oestrogens and HRT
 note 

Oestrogen for the treatment of patients with gender dysphoria is classified as Amber 2 (Specialist initiation) in line with NHS England guidance (pg 30-31) Dosing and monitoring information is contained in the Royal College of Psychiatrists guidelines (see page 39 onwards)

There are several national shortages presently. Prescribers are advised to review the advice from the British Menopause Society and if unsure consult their medicines management pharmacist to discuss an alternative product. (Aug 2019)

Oestrogen only HRT tablet (Elleste-Solo, Premarin)
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Formulary
Green

Elleste-Solo®- Estradiol tablet 1mg and 2mg (First choice oral estradiol only product)
Premarin®- Conjugated oestrogens tablet

 
   
Oestrogen only HRT patch (Estradot, Evorel, Elleste-Solo)
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Formulary
Green
  • Evorel® (cheaper, stocked at SFH)
  • Estradot®
  • Elleste-Solo® MX
 
   
Oestrogel ® (Estradiol gel)
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Formulary
Green
Oestrogel®
 
   
Combined continuous HRT tablet (Kliofem, Kliovance, Femoston Conti, Premique low dose)
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Formulary
Green

Kliofem® tablet
Kliovance® tablet (lower strength than Kliofem®)
Femoston®-conti tablets
Premique® tablet discontinued December 2016, now only Premique ® low dose tablet available

  • No bleed products
 
   
Combined continuous HRT patch (Evorel® Conti)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Evorel® Conti patches
  • No bleed products
     
  •    
    Combined cyclical HRT tablet (Elleste-Duet®, Femoston)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
    Elleste-Duet®- tablet 1mg and 2mg
    Femoston® 1/10 and 2/10 tablet
    Prempak-C® discontinued January 2017 
       
    Combined cyclical HRT patch (Evorel® Sequi)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Green
  • Evorel® Sequi patches 
  •    
    Tibolone (Livial®)
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    Formulary
    Green
    Tablet 
    Link  MHRA information on breast cancer risks Feb 2009
       
    06.04.01.01  Expand sub section  Ethinylestradiol
    Ethinylestradiol
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    Tablet 10mcg
    Tablet 2mcg for paediatric use - named patient use 
    Link  See unexpectedly expensive medicines list
       
    06.04.01.01  Expand sub section  Raloxifene
    Raloxifene Hydrochloride (Evista®)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2
    Tablet
    Amber 2 - Treatment and prevention of osteoporosis 
    Link  NICE quick reference guide on osteoporosis
    Link  NICE: Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (TA161)
    Link  NICE: Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women (TA160)
    Link  Nottinghamshire osteoporosis treatment guidelines July 2019
       
     ....
     Non Formulary Items
    Angeliq®  (Combined continuous HRT tablet)

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    Non Formulary
    Grey
    Contains estradiol 1mg and drospirenone 2mg
    Link  Link to reviews
     
    Bazedoxifene/conjugated oestrogens  (Duavive®)

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    Non Formulary
    Grey
    • No formal assessment
    • Due to be discontinued Decmeber 2019
    Link  Link to reviews
     
    Bedol®  (Oestrogen only HRT tablet)

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    Non Formulary
    Grey
     
    Climagest®  (Combined cyclical HRT tablet)

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    Non Formulary
    Grey
    Discontinued
     
    Climaval®  (Oestrogen only HRT tablet)

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    Non Formulary
    Grey
    Discontinued Jan 2016
     
    Climesse®  (Combined continuous HRT tablet)

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    Non Formulary
    Grey
    Discontinued
     
    Clinorette®  (Combined cyclical HRT tablet)

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    Non Formulary
    Grey
    Contains same active ingredients as Elleste Duet® (see above).
     
    Cyclo-Progynova®  (Combined cyclical HRT tablet)

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    Non Formulary
    Grey
     
    Elleste-Duet Conti®  (Combined continuous HRT tablet)

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    Non Formulary
    Grey
    Contains same active ingredients as Kliofem®- see above (APC July 2011).
     
    Estracombi®  (Combined cyclical HRT patch)

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    Non Formulary
    Grey
    Discontinued
     
    Estraderm MX®
    (Oestrogen only HRT patch)

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    Non Formulary
    Grey
     
    Estraderm TTS®  (Oestrogen only HRT patch)

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    Non Formulary
    Grey
    TTS 25 and TTS 100 Discontinued Jan 2012
     
    Estradiol Hemihydrate  (Lenzetto® 1.53 mg/spray)

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    Non Formulary
    Grey

    transdermal spray

    • No formal assesment
     
    Estradiol implant

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    Non Formulary
    Green
  • Discontinued July 2011. See SFH memo July 2011.
  • Unlicensed 25mg and 50mg implants were available from abroad but do not have satisfactory quality assurance.
  •  
    Femapak®
    (Combined cyclical HRT)

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    Non Formulary
    Grey
    Discontinued
     
    Fematrix®  (Oestrogen only HRT patch)

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    Non Formulary
    Grey
    Discontinued Aug 2012
     
    FemSeven®  (Oestrogen only HRT patch)

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    Non Formulary
    Grey
     
    FemSeven® Conti  (Combined continuous HRT patch)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    FemSeven® Sequi  (Combined cyclical HRT patch)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
    FemTab®  (Oestrogen only HRT tablet)

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    Non Formulary
    Grey
    Discontinued
     
    FemTab® Sequi
    (Combined cyclical HRT tablet)

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    Non Formulary
    Grey
    Discontinued
     
    Harmogen®
    (Oestrogen only HRT tablet)

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    Non Formulary
    Grey
    Discontinued
     
    Hormonin®
    (Oestrogen only HRT tablet)

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    Non Formulary
    Grey
    Discontinued
     
    Indivina®
    (Combined continuous HRT tablet)

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    Non Formulary
    Grey
     
    Novofem®
    (Combined cyclical HRT tablet)

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    Non Formulary
    Grey
    Contains same active ingredients as Elleste Duet® (see above).
     
    Nuvelle®  (Combined cyclical HRT tablet)

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    Non Formulary
    Grey
    Discontinued
     
    Ovestin®
    (Oestrogen only HRT tablet)

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    Non Formulary
    Grey
    Discontinued
     
    Progynova®  (Oestrogen only HRT tablet)

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    Non Formulary
    Grey
    APC July 2011
     
    Progynova® TS
    (Oestrogen only HRT patch)

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    Non Formulary
    Grey
    APC July 2011
     
    Sandrena®  (Estradiol gel)

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    Non Formulary
    Grey
    Oestrogel® is topical oestrogen gel of choice (see above)
     
    Tridestra®
    (Combined cyclical HRT tablet)

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    Non Formulary
    Grey
     
    Trisequens®
    (Combined cyclical HRT tablet)

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    Non Formulary
    Grey
     
    Zumenon®
    (Oestrogen only HRT tablet)

    View adult BNF View SPC online View childrens BNF
    Non Formulary
    Grey
     
      
    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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