Section 6: Endocrine System

Section Description

BNF 6.1

Drugs used in diabetes

BNF 6.1.1

Insulins

BNF 6.1.1.3

Hypodermic equipment

BNF 6.1.2

Oral antidiabetic drugs

BNF 6.1.2.1

Sulphonylureas

BNF 6.1.2.2

Biguanides

BNF 6.1.2.3

Other antidiabetics

BNF 6.1.3

Diabetic ketoacidosis

BNF 6.1.4

Treatment of hypoglycaemia

BNF 6.1.5

Treatment of diabetic nephropathy and neuropathy

BNF 6.1.6

Diagnostic and monitoring agents for diabetes mellitus

BNF 6.2.1

Thyroid hormones

BNF 6.2.2

Antithyroid drugs

BNF 6.3

Corticosteroids

BNF 6.3.1

Replacement therapy

BNF 6.3.2

Glucocorticoid therapy

BNF 6.4

Sex hormones

BNF 6.4.1

Female sex hormones

BNF 6.4.1.2

Progestogens

BNF 6.4.2

Male sex hormones and antagonists

BNF 6.4.3 

Anabolic steroids

BNF 6.5.1

Hypothalamic and anterior pituitary hormones & anti-oestrogens

BNF 6.5.2

Posterior pituitary hormones and antagonists

BNF 6.6

Drugs affecting bone metabolism

BNF 6.6.1

Calcitonin and teriparatide

BNF 6.6.2

Bisphosphonates and other drugs affecting bone metabolism

BNF 6.7

Other endocrine drugs

BNF 6.7.1

Bromocriptine and other dopaminergic drugs

BNF 6.7.2

Drugs affecting gonadotrophins

BNF 6.7.3

Metyrapone

BNF 6.7.4

Somatomedins

BNF 6.1 Drugs used in diabetes

BNF 6.1.1 Insulins

Continuous SC infusion for the treatment of diabetes mellitus  NICE TA151

Insulin preparations should be prescribed by brand name.

Product Name

Action

Product details

Pack

Abasaglar®
Insulin glargine
Substitution and automatic switching from Lantus® to Abasaglar® CANNOT be undertaken.

Long acting  

3ml cartridges
3ml Kwikpens  
1 x 5
1 x 5

Actrapid®
Soluble insulin (human, pyr)

Short acting

10ml vial

1

Apidra®
Insulin glulisine

Short acting

10ml vial
3ml cartridge for ClikSTAR® & Autopen 24®
3ml SoloSTAR® pre-filled device

1
1 x 5
1 x 5

Fiasp®
Insulin aspart (prescribe by brand name to avoid confusion)

Short acting

10ml vial
3ml Penfill® cartridge for NovoPen®
3ml FlexTouch pre-filled device 

1
1 x 5
1 x 5

Humalog®
Insulin lispro (prescribe by brand name to avoid confusion)

Short acting

100 units/ml
10ml vial
3ml Humalog® KwikPen pre-filled device
3ml cartridge for Autopen® Classic 3ml or HumaPen®


1
1 x 5
1 x 5

200 units/ml
3ml Humalog® KwikPen pre-filled device


  1 x 5

Humalog® Mix25
Biphasic insulin lispro

Biphasic

3ml KwikPen® pre-loaded pen
3ml cartridge for Autopen® 3ml or HumaPen®

1 x 5
1 x 5

Humalog® Mix50
Biphasic insulin lispro

Biphasic

3ml KwikPen® pre-loaded pen
3ml cartridge for Autopen® 3ml or HumaPen®

1 x 5
1 x 5

Humulin I®
Isophane insulin (human, prb)

Intermediate

10ml vial
3ml cartridge for Autopen® 3ml or HumaPen®
3ml Humulin I KwikPen® pre-filled device

1
1 x 5
1 x 5

Humulin M3®
Biphasic isophane (human, prb)

Biphasic

10ml vial
3ml cartridge for Autopen Classic® 3ml or HumaPen®

1
1 x 5

Humulin S®
Soluble insulin (human, prb)

Short acting

10ml vial
3ml cartridge for Autopen Classic® 3ml or HumaPen®

1
1 x 5

Hypurin® Bovine Neutral
Soluble insulin (bovine)

Short acting

10ml vial
3ml cartridge for Autopen® Classic device

1
1 x 5

Hypurin® Porcine Neutral
Soluble insulin (porcine)

Short acting

10ml vial
3ml cartridge for Autopen® Classic device

1
1 x 5

Hypurin® Bovine Isophane
Isophane insulin (bovine)

Intermediate

10ml vial
3ml cartridge for Autopen® Classic device

1
1 x 5

Hypurin® Bovine Lente
Insulin Zinc suspension (bov)

Long acting

10ml vial

1

Hypurin® Bovine Protamine Zinc

Intermediate

10ml vial

1

Hypurin® Porcine 30/70 Mix
Biphasic isophane insulin (pork)

Biphasic

10ml vial
3ml cartridge for Autopen® Classic device

1
1 x 5

Hypurin® Porcine Isophane
Isophane insulin (porcine)

Intermediate

10ml vial
3ml cartridge for Autopen® Classic device

1
1 x 5

Insulatard®
Isophane insulin (human, pyr)

Intermediate

10ml vial
3ml Penfill® cartridge for NovoPen®
3ml InnoLet® device

1
1 x 5
1 x 5

Insuman® Basal
Isophane insulin (human, crb)

Intermediate

5ml vial
3ml cartridge for ClickSTAR® and Autopen 24®
3ml Solostar® pre-filled device

1
1 x 5
1 x 5

Insuman® Comb 15
Biphasic isophane (human, crb)

Biphasic

3ml cartridge for ClickSTAR® and Autopen 24®

1 x 5

Insuman® Comb 25
Biphasic isophane (human, crb)

Biphasic

5ml vial
3ml cartridge for ClickSTAR® and Autopen 24®
3ml Solostar® pre-filled device

1
1 x 5
1 x 5

Insuman® Comb 50
Biphasic isophane (human, crb)

Biphasic

3ml cartridge for ClickSTAR® and Autopen 24®

1 x 5

Insuman® Rapid
Soluble insulin (human, crb)
Not recommended for use in SC infusion pumps

Short acting

3ml cartridge for ClickSTAR® and Autopen 24®

1 x 5

Lantus®
Insulin glargine NICE TA53(Aug15)

Long acting

10ml vial
3ml cartridge for ClickSTAR® and Autopen 24®
3ml Solostar® pre-filled device

1
1 x 5

Levemir®
Insulin detemir

Long acting

3ml cartridge for NovoPen® device
3ml FlexPen® pre-filled device
3ml InnoLet prefilled device

1 x 5
1 x 5
1 x 5

NovoMix® 30
Biphasic insulin aspart

Biphasic

3ml Penfill® cartridge for NovoPen®
3ml FlexPen® pre-filled device

1 x 5
1 x 5

NovoRapid®
Insulin aspart

Short acting

10ml vial
3ml Penfill® cartridge for NovoPen®
3ml FlexPen® pre-filled device
3ml FlexTouch pre-filled device

1
1 x 5
1 x 5
1 x 5

Toujeo®
Insulin glargine (prescribe by brand name to avoid confusion)  

Long-acting

300 units/ml
Toujeo® SoloStar pre-filled device 1.5ml

1 x 3
Tresiba®
Insulin degludec
2nd Line - To be initiated and stabilised by diabetes specialists - can be continued in primary care once stable MTRAC guidance for Insulin Degludec

Long acting

100 units/ml
3ml FlexTouch®pre-filled device
3ml Penfill® cartridge for Novopen® and NovoPen Echo®


1 x 5
1 x 5 
200 units/ml
3ml FlexTouch®pre-filled device
1 x 3

Insulin degledec with liraglutide (also known as IdegLira)- see BNF 6.1.2.3

BNF 6.1.1.3 Hypodermic equipment

Lancets & Finger-Pricking Devices

Finger pricking device
(not available on FP10)

Compatible Lancet (available on FP10)

Autolet Impression (Owen Mumford)

Unilet Comfortouch® 0.375mm/28 gauge

Monojector (Kendall)

B-D Micro-Fine® Plus 0.2mm/ 33 gauge or any type A lancet

Penlet (Lifescan)

B-D Micro-Fine® Plus 0.2mm/ 33 gauge or any type A lancet

Soft Touch (Roche)

B-D Micro-Fine® Plus 0.2mm/ 33 gauge or any type A lancet

Accu-Check Softclix

Softclix® 0.4mm/ 28 gauge or Softclix XL® 0.8mm/ 21 gauge

AgaMatrix AgaMatrix Ultra-thin lancets
One Touch Delicia One Touch Delicia

Safety Lancets

GlucoRx Safety lancets

 

1.6mm/30 gauge
1.8mm/28 gauge
1.8mm/ 26 gauge
2.2mm/ 23 gauge
 

Reusable Pens

See British National Formulary or Medicines Complete for information

Hypodermic Needles

All compatible with UK insulin and GLP-1 pens

BD Micro-Fine+

5mm/31 gauge

8mm/31 gauge
BD Micro-Fine Ultra
(formerly BD Micro-Fine+)
4mm/33 gauge
GlucoRx Fine Point

 

4mm/31gauge
5mm/31gauge
6mm/31gauge
8mm/31gauge
10mm/29gauge

12mm/29gauge

Mylife Clickfine AutoProtect pen needles For use in patients needing the support of a healthcare professional to administer medication via a pen device.

Syringes for use with U100 Insulin

B-D Micro-Fine Plus U100 0.3ml, 0.5ml & 1ml

Insulin syringe with permanently attached needle

BD SafetyGlide Insulin Syringe with needle

 

8mm 0.3ml syringe and needle (0.25mm/31G)
8mm 0.5ml syringe and needle (0.3mm/30G)
12mm 0.5ml syringe and needle (0.33mm/29G)
12mm 1.0ml syringe and needle (0.33mm/29G)
 

Accessories

BNF 6.1.2  Oral antidiabetic drugs

BNF 6.1.2.1 Sulphonylureas

Glimepiride oral

Regular FBC and liver function tests.

Gliclazide oral

Regular FBC and liver function tests.

BNF 6.1.2.2 Biguanides

Metformin oral

 

BNF 6.1.2.3 Other antidiabetics

ALPHA GLUCOSIDASE INHIBITORS 
Acarbose

 

DIPEPTIDYLPEPTIDASE-4-INHIBITORS (GLIPTINS) 
Alogliptin oral  
Linagliptin oral  
Sitagliptin oral  
GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS 
Dulaglutide injection

The recommended dose is 0.75 mg once weekly as monotherapy and 1.5 mg once weekly as add-on therapy, by subcutaneous injection. A reduction in the dose of sulfonylurea or prandial insulin may be considered to reduce the risk of hypoglycaemia when dulaglutide is used in combination with these therapies.

For potentially vulnerable populations, such as people aged 75 years or older, 0.75 mg once weekly can be considered as a starting dose. For people with mild or moderate renal impairment no dose adjustment is necessary. Dulaglutide is not recommended for people with severe renal impairment (eGFR less than 30 ml/minute/1.73 m2) or on dialysis.  

Exenatide injection   Use in line with NICE NG28
Exenatide WEEKLY injection Initiated in secondary care by diabetologist, then for continued prescribing in primary care. Use in line with NICE NG28
Liraglutide injection Use in line with NICE NG28
1.8mg daily is not recommended
Liraglutide + insulin degludec injection (Xulotophy®)  For type 2 diabetics (HbA1c>9%) on oral hypoglycaemic agents, with or without basal insulin, where weight loss is desirable. Suitable for primary care prescribing after specialist initiation and stabilisation, or by GPs with special interest 
Lixisenatide injection Use in line with NICE NG28
MEGLITIDINES 
Nateglinide oral  Use in line with NICE NG28 
SODIUM GLUCOSE CO-TRANSPORTER 2 INHIBITORS 
Canagliflozin Use in line with NICE TA315 and NICE TA390
Dapagliflozin Use in line with NICE TA288 and NICE TA390
Empagliflozin Use in line with NICE TA336 and NICE TA390
THIAZOLIDINEDIONES

Pioglitazone

Use in line with NICE NG28. Pioglitazone prescribed as generic for all indications

BNF 6.1.3 Diabetic ketoacidosis

Refer to local RWT guidelines

BNF 6.1.4 Treatment of hypoglycaemia

Initially glucose 10 – 20 g is given by mouth either in liquid form or as granulated sugar. 
If necessary this may be repeated every 10 - 15 minutes.

Approximately 10g of glucose is available from:
2 teaspoons of sugar
3 sugar lumps
Glucogel® (formerly known as Hypostop Gel®)
Dextro Energy tablets
Non-diet versions of Lucozade® Sparkling Glucose Drink 50 – 55 mL
Coca-Cola® 60 mL
Ribena® Original 15 mL (to be diluted)

Glucagon injection

GlucaGen HypoKit®

Diazoxide injection

Specialist/ hospital prescribing only

BNF 6.1.5 Treatment of diabetic nephropathy and neuropathy

Also see BNF 4.7.3

Duloxetine oral

NICE CG173
If duloxetine is ineffective or unsuitable consider amitriptyline [unlicensed use] starting at 10mg daily.

Midodrine oral (Bramox®) Licensed for treatment of orthostatic hypotension. Suitable for prescribing in primary care following initiation by specialist.
Nortriptyline oral Unlicensed use - NICE CG173

BNF 6.1.6 Diagnostic and monitoring agents for diabetes mellitus

There are currently more than sixty blood glucose monitoring machines on the UK market.

Approved blood glucose monitoring machines

The choice of meters has been made following full consultation with healthcare professionals in Wolverhampton.

Freestyle Libre glucose monitoring system should be initiated only by a Specialist for Type 1 diabetes patients and continued in primary care only where the patient attends regular specialist reviews. 

Patients using Freestyle Libre will be required to check fingerstick blood glucose using Freestyle Optium blood glucose test strips (1) before driving (2) if blood glucose is changing quickly and patient is unsure if flash result is accurate (3) to confirm hypoglycemia and to check if hypo has been adequately recovered.  

Flash Glucose Commissioning Document

Testing frequency

The Drug Tariff states that one pack of 50 strips would normally be sufficient for 2 months which fits well with the Diabetes Team recommendation that patients should test approximately once a day (50 times over two months) testing in a 4-point profile. The testing method is detailed in this patient leaflet
Intensified blood glucose monitoring up to four times (or more) a day is indicated in the presence of:

Home blood glucose testing can encourage self-care and contribute to patient education. Home blood glucose monitoring information from Wolverhampton Diabetes Centre.

Advice on the issue and quality control of blood glucose meters from Wolverhampton Diabetes Centre

URINALYSIS - Glucose

Diastix®

Clinistix® more expensive

URINAYLSIS - Ketones

Ketostix®

 

URINALYSIS - Protein

Medi-Test® Protein 2

Albustix® more expensive

Glucose Tolerance Test          

See British National Formulary or medicines Complete for further infromation

BNF 6.2.1 Thyroid hormones

Levothyroxine sodium oral

Thyroid function test (TFT) every 12-15 months for patients stabilised on levothyroxine.

SEVERE HYPOTHYROID STATE

Liothyronine sodium oral

Prescribing initiated and regularly reviewed with regard to on-going clinical need by consultant NHS endocrinologist may be continued in primary care. 

BNF 6.2.2 Antithyroid drugs

Carbimazole oral

CSM warning (neutropenia and agranulocytosis). Patient should be asked to report signs and symptoms of an infection, especially a sore throat. Check white blood cell count if there is clinical evidence of an infection. Stop carbimazole promptly if there is evidence of neutropenia.

Aqueous iodine oral solution

(Lugol’s Solution). Specialist/ hospital prescribing only

Propylthiouracil oral

Suitable for prescribing in primary care following specialist initiation 

BNF 6.3 Corticosteroids

A Steroid treatment card can be found in section 3.2

BNF 6.3.1 Replacement therapy

Fludrocortisone oral

 

BNF 6.3.2 Glucocorticoid therapy

Consider prescribing osteoporosis prophylaxis [BNF 9.5.1] for all adult patients about to commence or currently prescribed an oral dose of 7.5mg per day or more of prednisolone (or equivalent dose of another corticosteroid) for six months or more.

Betamethasone oral & injection

 

Cortisone acetate oral

 

Dexametasone oral & injection

 

Hydrocortisone oral & injection

 

Methylprednisolone oral & injection

 

Prednisolone oral and injection

 
Triamcinolone injection Specialist/ hospital prescribing only

BNF 6.4 Sex hormones

Gender dysphoria: Primary Care Responsibility in Prescribing and Monitoring Hormone replacement therapy for transgender and non-binary adults (updated) SSC1620; Focus on gender incongruence in primary care BMA

BNF 6.4.1 Female sex hormones

The current British National Formulary details the risks associated with HRT and how these might be discussed with patients.

Product details

Oestrogen

Progestogen

WOMEN WITH INTACT UTERUS - Relief of menopausal symptoms without bleeds
Continuous combined therapy suitable if 1-3 years of amenorrhoea or aged >54 years if already on sequential HRT.

Tablets

Kliovance®

Estradiol 1mg

Norethisterone acetate 500mcg

Elleste Duet Conti®

Estradiol 1mg

Norethisterone acetate 1mg

Femoston-Conti®

Estradiol 1mg

Dydrogesterone 5mg

Climesse®

Estradiol valerate 2mg

Norethisterone 700mcg

Premique®

Conj. oestrogen 625mcg

Medroxyprogesterone acetate 5mg

Patches

Evorel Conti®

Estradiol 50mcg

Norethisterone acetate 170mcg

WOMEN WITH INTACT UTERUS - Relief of menopausal symptoms with monthly bleeds
Sequential combined therapy suitable for perimenopausal women. These products attract 2 prescription charges.

Tablets

Elleste Duet® 1mg

Estradiol 1mg

Norethisterone acetate 1mg

Elleste Duet® 2mg

Estradiol 2mg

Norethisterone acetate 1mg

Femoston® 1/10

Estradiol 1mg

Dydrogesterone 10mg

Femoston® 2/10

Estradiol 2mg

Dydrogesterone 10mg

Patches

Evorel Sequi®

Estradiol 50mcg

Norethisterone acetate 170mcg

WOMEN WITH INTACT UTERUS - Relief of menopausal symptoms with quarterly bleeds
Sequential combined therapy suitable for perimenopausal women. These products attract 2 prescription charges.

Tablets

Tridestra®

Estradiol valerate 2mg

Medroxyprogesterone acetate 20mg

WOMEN WITHOUT UTERUS - Relief of menopausal symptoms without bleeds
Unopposed estrogen therapy

Tablets

Elleste Solo® 1mg

Estradiol 1mg

 

Elleste Solo® 2mg

Estradiol 2mg

 

Patches

Evorel®

Estradiol 25mcg, 50mcg, 75mcg & 100mcg

 

Gel

Oestrogel®

Estradiol 0.06%

 

Sandrena®

Estradiol 0.1%

 

Locally applied HRT products for short-term treatment of vaginal atrophy  can be found in section 7.2.1 .

OTHER PREPARATIONS

Raloxifene oral

Does not reduce menopausal vasomotor symptoms

Tibolone oral

 

Ethinylestradiol oral

 

BNF 6.4.1.2 Progestogens

Heavy menstrual bleeding: assessment and management NICE CG44  

UKMI Q&A: Progesterone/Progestogen supplementation and postnatal depression QA 183.5

Dydrogesterone oral

 

Medroxyprogesterone oral

 

Norethisterone oral

 

Progesterone pessaries (Cyclogest®) 

Specialist/ hospital prescribing only

BNF 6.4.2 Male sex hormones and antagonists

Testosterone undecanoate capsules

Restandol®. Suitable for prescribing in primary care following specialist/ hospital initiation.

Testosterone undecanoate injection

Nebido®. Suitable for prescribing in primary care following specialist/ hospital initiation.

Testosterone propionate injection

Sustanon®. Suitable for prescribing in primary care following specialist/ hospital initiation. 

Mesterolone oral

 

Anti-androgens

see Section 7.4.1 for more details

Cyproterone acetate oral

 

Dutasteride oral

 

Finasteride oral

 

BNF 6.4.3 Anabolic steroids

Oxandrolone oral Specialist/ Hospital prescribing

BNF 6.5.1 Hypothalamic and anterior pituitary hormones & anti-oestrogens

Anti-oestrogens

Clomifene Citrate   (Clomiphene Citrate)

Polycystic Ovary Syndrome: Clomifene is first-line treatment for women with polycystic ovary syndrome (PCOS): clomifene citrate should be offered for a maximum of 6 months

Fertility problems: assessment and treatment NICE CG156 Do not offer clomifene citrate, anastrozole or letrozole to women with unexplained infertility.  

Fertility Service: The commissioned fertility service includes medication costs therefore it should not be necessary for individual GPs to prescribe drugs for IVF. Patients receiving treatment privately should have their drugs prescribed privately by the appropriate hospital consultant.  

Anterior pituitary hormones

Tetracosactide    (Tetracosactrin) injection

Synacthen®

Gonadotrophins

 

Chorionic Gonadotrophin injection

Human Chorionic Gonadotrophin; HCG

Growth hormone

 

Somatropin injection

Synthetic Human Growth Hormone

NICE Guidance (Somatropin for adults with growth hormone deficiency) NICE TA64

NICE Guidance- Human growth hormone (somatropin) for the treatment of growth failure in children (review) NICE TA188

Growth hormone receptor antagonists

Thyrotropin alfa injection

 

Hypothalamic hormones

 

Gonadorelin injection

Gonadotrophin-releasing hormone; GnRH; LH-RH.

BNF 6.5.2 Posterior pituitary hormones and antagonists

Argipressin injection synthetic vasopressin
Vasopressin injection

as argipressin

Desmopressin oral, sublingual, nasal & injection

Terlipressin injection

 

Antidiuretic hormone antagonists

Demeclocycline oral

see antibiotic guidance, BNF section 5.1.3
Tolvaptan oral  Tolvaptan for treating autosomal dominant polycystic kidney disease NICE TA358 

BNF 6.6 Drugs affecting bone metabolism

OSTEOPOROSIS

BNF 6.6.1 Calcitonin and teriparatide

Calcitonin (Salmon)/ Salcatonin injection and nasal spray

Specialist/ Hospital prescribing only

Teriparatide injection

Specialist/ Hospital prescribing only. See NICE TA161

BNF 6.6.2 Bisphosphonates and other drugs affecting bone metabolism

Osteoporosis: Assessing the risk of fragility fractures NICE CG146

Primary Prevention of osteoporotic fractures in postmenopausal women NICE TA160 

Secondary Prevention of osteoporotic fractures in postmenopausal women NICE TA161

Bisphosphonates for treating osteoporosis NICE TA464

Falls: assessment and prevention of falls in older people NICE CG161 

Clinical guideline for prevention and treatment of osteoporosis (March 2014)

Bisphosphonate length of treatment guidelines (Derbyshire)

UKMI Q&A Gastric adverse events influencing the choice of bisphosphonate QA204 

UKMI Q&A Proton Pump Inhibitor interactions with bisphosphonates QA194 

UKMI Q&A Renal impairment and use of bisphosphonates  QA169

Bisphosphonate for osteoporosis Leaflet for patients

Alendronate oral daily & once weekly

 

Risedronate oral daily & once weekly

 

Ibandronic Acid 150mg (Bonviva®) once a month   
Denosumab injection  Prevention of osteoporotic fractures in postmenopausal women in accordance with NICE TA204
Strontium ranelate oral  Suitable for prescribing in primary care following initiation by secondary care specialist. For treatment of severe osteoporosis - see MHRA advice  
Zoledronic acid infusion   Annual injection – additional sundry & administration costs Specialist/ Hospital prescribing only  
Sodium clodronate oral  Specialist/ Hospital prescribing only 
 

HYPERCALCAEMIA OF MALIGNANCY

Disodium pamidronate infusion

Specialist/ Hospital prescribing only  

Ibandronic acid tablets  
Ibandronic acid infusion Specialist/ Hospital prescribing only. RWT - for use in oncology only
Denosumab (XGEVA®)   Bone metastases from solid tumours – denosumab NICE TA265

 

BNF 6.7 Other endocrine drugs

BNF 6.7.1 Bromocriptine and other dopaminergic drugs

Bromocriptine oral

 

Cabergoline oral

Suitable for prescribing in primary care following specialist/ hospital initiation. When prescribing cabergoline:

  • Monitor patients for signs of cardiac fibrosis during treatment
  • Echocardiography should be done within 3–6 months of starting treatment and subsequently at 6–12-month intervals
  • Stop treatment if echocardiography shows new or worsened valvular regurgitation, valvular restriction, or valve leaflet thickening
  • Maximum daily dose of cabergoline is now restricted to 3mg/day in the treatment of Parkinson’s disease
  • Pregnancy should be excluded before administration of cabergoline
  • Women who are planning pregnancy should stop taking cabergoline 1 month before they try to conceive

BNF 6.7.2 Drugs affecting gonadotrophins

Danazol oral

Suitable for prescribing in primary care following specialist/ hospital initiation.  

Gonadorelin analogues

Buserelin injection

Specialist/ Hospital prescribing only 

Goserelin injection

Suitable for prescribing in primary care following specialist/ hospital initiation.  

Leuprorelin injection

Suitable for prescribing in primary care following specialist/ hospital initiation.  

Nafarelin nasal spray

Specialist/ Hospital prescribing only. The commissioned fertility service includes medication costs therefore it should not be necessary for individual GPs to prescribe drugs for IVF. Patients receiving treatment privately should have their drugs prescribed privately by the appropriate hospital consultant. 

Triptorelin injection Suitable for prescribing in primary care following specialist/ hospital initiation.  

BNF 6.7.3 Metyrapone  

Metyrapone is not stocked by Royal Wolverhampton NHS Trust and is not suitable for GP prescribing.

BNF 6.7.4 Somatomedins  

Mecasermin

Not suitable for prescribing in primary care.
NHSE Commissioning advice click here