| Formulary Chapter 6: Endocrine system - Full Chapter
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| Chapter Links... |
 LSCMMG: Trans Female Gender Dysphoria Information Sheet |
| LSCMMG: Trans Male Gender Dysphoria Information Sheet |
| Details... |
| 06.03.02 |
Glucocorticoid therapy |
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A patient information leaflet should be supplied to every patient when a systemic corticosteroid is prescribed.
Steroid Treatment Cards should be issued where appropriate to support communication of the risks associated with treatment and to record details of the prescriber, drug, dosage, and duration of treatment.
Steroid Emergency Cards should be issued to patients with adrenal insufficiency and steroid dependence for whom missed doses, illness, or surgery puts them at risk of adrenal crisis.
For further detailed information see https://bnf.nice.org.uk/drugs/prednisolone/. |
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Betamethasone soluble tablets
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Formulary
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Soluble tablets 500micrograms
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 MHRA: Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
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Dexamethasone
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Formulary
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Tablets 500micrograms, 2mg
Liquid 2mg/5mL, 500micrograms/5mL, 10mg/5mL
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MHRA: Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
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Hydrocortisone tablets
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Formulary
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Tablets 10mg, 20mg
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MHRA: Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
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Prednisolone
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Formulary
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Tablets 1mg, 5mg
e/c tablets 2.5mg
25mg tablets are classified as 
There is no evidence that e/c prednisolone reduces the risk of gastrointestinal side effects. Uncoated tablets should be prescribed first line together with a PPI if necessary.
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MHRA: Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
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Betamethasone injection
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Formulary
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Injection 4mg/1mL
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MHRA: Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
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Deflazacort
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Formulary
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Should only be used for patients in whom oral prednisolone is not tolerated due to cushingoid side effects.
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Hydrocortisone (Alkindi®)
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Formulary
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Granules in capsules for opening 0.5mg, 1mg, 2mg
For replacement therapy of adrenal insufficiency in children and adolescents (from birth to <18 years old)
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LSCMMG: Hydrocortisone capsules
MHRA: Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
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Hydrocortisone MR capsules (Efmody)
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Formulary
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Treatment of congenital adrenal hyperplasia (CAH) in adolescents aged 12 years and over and adults.
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LSCMMG: Hydrocortisone modified-release hard capsules
MHRA: Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
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Hydrocortisone sodium phosphate (Efcortesol®)
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Formulary
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Injection 100mg/1mL
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Addison's Disease Self Help Group: What to do in an emergency
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Hydrocortisone sodium succinate (Solu-Cortef®)
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Formulary
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Injection 100mg vial
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Addison’s Disease Self Help Group: What to do in an emergency
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Triamcinolone (Kenalog®)
(acetonide)
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Formulary
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Intra-articular/intramuscular injection 40mg/1mL
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Hydrocortisone MR (Plenadren)
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Formulary
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| 06.03.02 |
Disadvantages of corticosteroids |
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| 06.03.02 |
Use of corticosteroids |
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| 06.03.02 |
Pregnancy and breastfeeding |
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| 06.03.02 |
Administration |
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| 06.03.02 |
Withdrawal of corticosteroids |
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Key |
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Restricted Drug |
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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
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Scottish Medicines Consortium |
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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Cancer Drugs Fund |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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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.
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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. |
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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. |
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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. |
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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). |
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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. |
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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.
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Refer to local guidance. |
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