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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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06.04.02  Expand sub section  Male sex hormones and antagonists
 note 

Testosterone 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)

06.04.02  Expand sub section  Anti-androgens
Finasteride
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Amber 3
Tablet
  • For use in Benign prostatic hyperplasia only (Amber 3) in line with guideline.
  • If needed tablets can be dispersed in water, but this should be done in a closed system- put the tablet in an oral syringe and suck up some water to dissolve it. More Info on crushing tablets
  • Dutasteride
    View adult BNF View SPC online View childrens BNF
    Second Choice
    Amber 2

    Capsule

    • Avoid contact with capsule contents.
    • Use finasteride first line which is supported by the MTOPS and PCPT trials.
    • Patients can be switched from dutasteride to finasteride in primary care if:
      - finasteride hasn't been tried before.
      - the patient has been on dutasteride for more than 3 months.
    • Amber 2 - Benign prostatic hyperplasia.
     
    Link  Link to reviews
       
    Cyproterone
    (Male hypersexuality)
    View adult BNF View SPC online View childrens BNF
    Formulary
    Amber 2

    Tablet

    • Monitor LFTs
    • If needed tablets can be dispersed in water, but this should be done in a closed system- put the tablet in an oral syringe and suck up some water to dissolve it. More info on crushing tablets.
    • Amber 2 - Severe hypersexuality and sexual deviation in males
     
    Link  MHRA drug safety update- only use cyproterone for hypersexuality if other interventions are inappropriate
       
     ....
    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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