North East and North Cumbria
ICS Formulary
 
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6 Endocrine system
06-03-02 Glucocorticoid therapy

Prednisolone
First Choice
  • The lowest cost formulation should be used when clinically appropriate.  Formulations approved include:
    • 1mg, 5mg tablets;
    • 5mg soluble tablets;
    • 1mg in 1ml oral solution (Prednisolone Dompé®);
    • 5mg suppositories.

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Hydrocortisone sodium phosphate Efcortesol®
Formulary
  • 100mg/ml solution for injection
  • As an additional option to hydrocortisone sodium succinate for patients who are steroid dependent (pituitary or adrenal cause and occasionally non-endocrine reasons for long term steroid use) to manage sick day rules to avoid an Addisonian crisis.
  • Paraesthesia and pain may follow intravenous injection.

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Dexamethasone
Formulary
  • 500microgram & 2mg tablets
  • 500microgram soluble tablets
  • 2mg in 5ml oral solution and 5mg in 5ml oral solution  is also approved. unlicensedunlicensed
  • 20mg/5ml oral solution Red
  • Approved for use in patients requiring high dose to reduce pill burden
Link  MHRA Alert (Oct 2014): Dexamethasone 4 mg/ml injection (Organon Laboratories Limited): reformulation with changes in name, concentration, storage conditions, and presentation

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Methylprednisolone sodium succinate 2mg, 4mg, and 16mg tablets
Formulary

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Dexamethasone 3.3mg in 1ml and 6.6mg in 2ml
Formulary
  • Note: there are two different strength preparations of dexamethasone injection available in the UK (3.8mg/ml and 3.3mg/ml) where traditionaly a 4mg/ml preparation was available and prescribed as such. To avoid confusion the 3.3mg/ml strength is the preparation of choice in the acute Trusts. Where previously a 4mg dose would have prescribed it is appropriate to prescribe a 3.3mg dose (or multiples thereof). This is because the range of doses given in clinical practice varies widely and subsequent doses tend to be adjusted to reflect clinical response. If 4mg is required please ensure that the appropriate volume of 3.3mg/ml is (e.g. 1.2ml) prescribed (or mulitples thereof).

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Hydrocortisone
Formulary
  • 10mg and 20mg tablets
  • 5mg, 10mg and 20mg dispersible tablets   
  • 2.5mg buccal tablets 
  • 5mg/5ml and 10mg/5ml oral solution (Colonis®)
  • In patients who are unable to swallow or have swallowing difficulties the most cost effective product should be used     
  • 0.5mg, 1mg, 2mg & 5mg granules (in capsules for opening) Green plus
    • Approved for treatment of adrenal insufficiency in infants, children and adolescents
    • Patients should be transitioned onto tablets once they are able to take them
Link  MHRA Drug Safety Update (Feb 2021): Alkindi (hydrocortisone granules): risk of acute adrenal insufficiency in children when switching from hydrocortisone tablet formulations to granules

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Methylprednisolone Acetate 40mgin 1ml and 120mg in 3ml (depot)
Formulary

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Methylprednisolone sodium succinate 40mg, 125mg, 500mg & 1000mg injection
Formulary
Link  MHRA Drug Safety Alert (Oct 2017): Methylprednisolone injectable medicine containing lactose (Solu-Medrone 40 mg): do not use in patients with cows’ milk allergy 
Link  NICE NG220: Multiple sclerosis in adults: management

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Triamcinolone acetonide 40 mg in 1ml
Formulary

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Betamethasone 4mg in 1ml
Formulary

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