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 Formulary Chapter 6: Endocrine system - Full Chapter
06.01.01.01  Expand sub section  Short-acting insulins
Actrapid® (Insulin)
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Formulary
Green
10mL vial

 
 
Humulin® S (Insulin)
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Formulary
Green
10mL vial
3mL cartridge for AutoPen® or HumaPen®
 
 
06.01.01.01  Expand sub section  Rapid Acting Insulin Analogues
Apidra® (Insulin Glulisine)
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Formulary
Green
10mL vial
3mL cartridge for OptiPen® Pro 1
3mL prefilled disposable pen SoloSTAR
 
 
Fiasp® (Insulin aspart)
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Formulary
Green Restricted

Injection 100 units/mL,
Penfill® cartridge for Fiasp® devices
Flextouch® prefilled disposable injection devices
Fiasp® and NovoRapid® are not interchangeable due to differences in bioavailability.

Must be commenced by a healthcare professional who is appropriately trained and experienced in the initiation of insulin.
Insulin Aspart (Fiasp®) is recommended for the treatment of diabetes mellitus in adults who are suitable for NovoRapid® and their diabetes cannot be adequately managed with alternative formulary choices and at least one of the following applies:
- where the prescriber believes a faster onset of action would be beneficial to the patient
- where a patient requires ‘tight’ control of blood sugar levels
- where a patient has rapid post meal increase in blood sugar levels

 
 
Humalog® (Insulin Lispro)
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Formulary
Green
10mL vial
3mL cartridge AutoPen® or HumaPen®
3mL prefilled disposable Humalog® KwikPen®
 
 
Lyumjev®Black Triangle (Insulin lispro)
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Formulary
Green Restricted

Injection 100 units/mL,

Solution for injection in vial

Solution for injection in cartridge

KwikPen® solution for injection in pre-filled pen

Junior KwikPen® solution for injection in pre-filled pen

 

Insulin Lispro (Lyumjev®) is recommended for the treatment of diabetes mellitus in adults who are suitable for Humalog® and their diabetes cannot be adequately managed with alternative formulary choices and at least one of the following applies:

-Where the prescriber believes a faster onset of action would be beneficial to the patient
- Where a patient requires ‘tight’ control of blood sugar levels
- Where a patient has rapid post-meal increase in blood sugar levels

 
 
Trurapi (Insulin Aspart (Biosimilar))
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Formulary
Green

First choice insulin aspart in new users

 
 
NovoRapid® (Insulin Aspart )
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Formulary
Green

10mL vial
3mL cartridge for NovoPen®
3mL prefilled disposable FlexPen®

Biosimilars are first line

 
 
06.01.01.01  Expand sub section  Short-acting human insulin analogues
 ....
Key
Restricted Drug Restricted Drug
Unlicensed Drug Unlicensed
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Link to adult BNF
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Link to children's BNF
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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
ICB
ICB
Green Low Carbon

Low carbon footprint

Amber Medium Carbon

Medium carbon footprint

Red High carbon footprint

High carbon footprint

Status Description

Green

Green: Appropriate for initiation and ongoing prescribing in both primary and secondary care. Generally, little or no routine drug monitoring is required.  

Green Restricted

Green (Restricted): Appropriate for initiation and ongoing prescribing in both primary and secondary care provided: Additional criteria specific to the medicine or device are met, or The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway. Generally, little or no routine drug monitoring is required.   

Red

Red medicines: Medicine is supplied by the hospital for the duration of the treatment course. Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP. Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this. Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care.  

Amber 0

Amber level 0: Suitable for prescribing in primary care following recommendation or initiation by a specialist. Little or no specific monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Brief prescribing document or information sheet may be required. Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information. When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe.  

Amber 1

Amber level 1 (with shared care): Suitable for prescribing in primary care following recommendation or initiation by a specialist. Minimal monitoring required. Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care.  

Amber 2

Amber level 2 (with shared care and enhanced service): Initiated by specialist and transferred to primary care following a successful initiation period. Significant monitoring required on an on-going basis. Full prior agreement about patient’s on-going care must be reached under the shared care agreement. Suitable for enhanced service. These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements).  

Do Not Prescribe

Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.  

Grey

Grey medicines: Medicines which have not yet been reviewed or are under the review process. GPs and specialists are recommended not to prescribe these drugs. This category includes drugs where funding has not yet been agreed.   

Multiple

Refer to local guidance and local commissioning arrangements  

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