North East and North Cumbria Formulary


	North East and North Cumbria ICS Formulary

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Formulary Chapter 6: Endocrine system - Full Chapter

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NTAG Endocrine System Recommendations

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06.01.01.01

Short-acting insulins

Note: preloaded pens and Innolet® devices should only be used where cartridges are not suitable.

Insulin (Actrapid^® )
(Rapidly acting)

Formulary

Human Actrapid® 10ml vial approved.

Insulin (Humulin^® S)
(Rapidly acting)

Formulary

Approved formulations of Humulin® S include:
- 10ml vials;
- 5x3ml cartridges.

Insulin Aspart (Fiasp^®)
(Ultra-fast, short acting)

Formulary

Approved formulations for Fiasp® include:
- 10ml vial;
- 5x3ml cartridge;
- 5x3ml FlexpTouch pen®.

Insulin Aspart (NovoRapid^® Trurapi^®)
(Very rapidly acting )

Formulary

Approved formulations for Novorapid® include:
- 10ml vial;
- 5x3ml cartridge (for use with Novopen and Novopenmate devices);
- 5x3ml Flexpen®.
Approved formulations for Trurapi® include:
- 100 units/ml 10ml vial
- 100 units/ml cartridge
- 100 units/ml pre-filled pen

Trurapi = BLACK TRIANGLE

Insulin Lispro 100 units/ml (Humalog^®)
(Very rapidly acting)

Formulary

Approved formulations for Humalog 100 ® include:
- 10ml vial;
- 5x3ml cartridge;
- 5x3ml Kwiikpen®.
Prescriptions need to be written as Insulin Lispro Sanofi^® or Humalog^® to avoid prescribing/dispensing errors.
Note that there are two strengths of Humalog® (insulin lispro). Caution should be exercised when prescribing and dispensing

Insulin Lispro 200 units/ml (Humalog^®)
(Very rapidly acting)

Formulary

200 units per ml
Approved formulations for Humalog 200® include the 5x3ml Kwikpen^®.
Note that there are two strengths of Humalog^® (insulin lispro). Caution should be exercised when prescribing and dispensing

Insulin Lispro Sanofi

(Very rapidly acting)

Formulary

100units /ml
10ml vial 3ml cartridges (for AllStar Pro and JuniorSTAR pen), 3ml SoloStar prefilled pen
Prescriptions need to be written as Insulin Lispro Sanofi^® or Humalog^® to avoid prescribing/dispensing errors. Insulin lispro biosimilar

Insulin Glulisine (Apidra^®)
(Very rapidly acting)

Formulary

Approved Apidra® formulations include:
- 10ml vials;
- 5x3ml cartridges
- 5x3ml Solostar® pens.

Insulin Human 500 units in 1mL (Humulin R^®)
(Rapidly acting)

Unlicensed

Humulin R 500units in 1ml (10ml vial) approved for a very small number of insulin resistant patients that require very high doses of insulin.

MHRA Drug Safety Update (Sep 2020): Insulins (all types): risk of cutaneous amyloidosis at injection site

NICE NG 17: Type 1 diabetes in adults: diagnosis and management

NICE TA151: Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus

06.01.01.01

Short-acting human insulin analogues

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.
	Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.
	Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.
	Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.
	NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.
	UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.
	NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.