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 Formulary Chapter 6: Endocrine system - Full Chapter
06.04.01.01  Expand sub section  Oestrogens and HRT
 note  Oestrogen for the treatment of patients with gender dysphoria is classified as Amber 2 (Specialist initiation) in line with NHS England guidance. Dosing and monitoring information is contained in the Royal College of Psychiatrists guidelines (see page 39 onwards).
Oestrogen only HRT tablet (Elleste-Solo ®, Premarin®,Progynova®, Zumenon®,)
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Formulary
Green
  • Elleste-Solo®- Tablet 1mg and 2mg (First choice oral estradiol only product).
  • For use in women without a uterus.
  • Elleste Solo: 1mg and 2mg estradiol.
  • Premarin: Conjugated oestrogens 0.3mg, 0.625mg and 1.25 mg.
  • Progynova: 1mg and 2mg estradiol valerate.
  • Zumenon: 1mg and 2mg estradiol.

December 2019 HRT Shortages: 

  • Current available brands - Beware, there can be variation in the licensing of different medicines containing the same drug:
    • Elleste-Solo® 1mg and 2mg tablets (Mylan) - Available to order via AAH, Alliance HC and Phoenix until late December 2019 and late January 2020, respectively. 
    • Premarin® (conjugated oestrogen) tablets (Pfizer) - Available to order via Alliance HC. 
    • Progynova® 1mg and 2mg tablets (Bayer) – Available to order via Alliance HC only.
    • Zumenon® 1mg and 2mg tablets (Mylan) – Available to order via AAH, Alliance HC and Phoenix. 
 
Link  December 2019: Shortages of HRT
   
Oestrogen only HRT patch
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Formulary
Green

 

  • Evorel® and Estradot® are the recommended brands for use in women without a uterus.

December 2019 HRT Shortages:

  • Shortage of Evorel® patches - all strengths are unavailable until February 2020.  
  • Supplies of Estradot® patches -  all strengths are filtering into Alliance and AAH on a weekly basis.



 

 
Link  December 2019: Shortages of HRT
   
Combined continuous HRT patch (Evorel® Conti, Femseven Conti)
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Formulary
Green

 

  • Evorel® Conti patches and Femseven® Conti patches are both approved for use second line where combined tablets are not suitable.
  • Evorel® Conti - estradiol 50mcg per 24 hour, norethisterone acetate 170mcg per 24 hour.
  • Femseven® Conti - estradiol 50mcg per 24 hour levonorgestrel 7mcg per 24 hour.
  • No bleed products for women with an intact uterus.
  • Please note above the differences in progesterone between these formulations.
  • Beware there are differences in licensing of the combined continuous HRT patches.
  • Please see SPC for further information. 

December 2019 HRT shortages:

  • Shortage of Femseven® Conti patches - Theramex the sole supplier have advised this range will be out of stock until mid 2020.  
  • Shortage of Evorel® Conti patches - These are unavailable until February 2020. 





 

 
Link  December 2019: Shortages of HRT
   
Combined continuous HRT tablet (Kliofem, Kliovance, Femoston Conti)
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Formulary
Green

 

  • No bleed products for women with intact uterus.
  • Tablets are the first line choice.
  • Kliovance and Kliofem are the most cost effective choices for continuous HRT products, containing estradiol and norethisterone.
  • Kliovance® is a lower strength than Kliofem®
  • Femoston®-conti tablets contains estradiol and dydrogesterone.

 

 

 

 
   
Sequential (cyclical) combined HRT tablet (Elleste-Duet®, Femoston ®, Tridestra ® )
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Formulary
Green

 

  • Tablets are the first line choice.
  • For women with a intact uterus.
  • Elleste Duet: 1mg and 2mg estradiol (both with 1mg norethisterone acetate).
  • Femoston: 1mg and 2mg estradiol (both with 10mg dydrogesterone).
  • Tridestra: 2mg estradiol with 20mg medroxyprogesterone.
  • Previous formulary choice of Prempak-C was discontinued in March 2017.

December 2019 HRT Shortages:

  • Shortage of Elleste Duet 1mg and 2mg tablets - currently both are available to order however it is expected these will be unavailable from the end of December 2019. 
 
Link  December 2019: Shortages of HRT
   
Sequential (cyclical) combined HRT patch (Evorel® Sequi, Femseven Sequi ®)
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Formulary
Green
  • Evorel®Sequi patches and FemSeven® Sequi patches.
  • Evorel®Sequi patches comprise of:
    • Evorel 50 (estradiol).
    • Evorel Conti (estradiol and norethisterone).
  • FemSeven®Sequi patches comprise of:
    • Phase 1 (estradiol).
    • Phase 2 (estradiol and levonorgestrel).
  • For women with an intact uterus.
  • Second line to tablets - avoids first pass effect so useful if renal impairment or raised triglycerides.
  • Please note above the differences in progesterone between these formulations.
  • Beware there are differences in licensing of the combined continuous HRT patches.
  • Please see SPC for further information.

December 2019 HRT Shortages: 

  • Shortage of Femseven® Sequi patches - Theramex the sole supplier expect stock to be available again mid-2020.
  • Shortage of Evorel® Sequi patches - These will be out of stock in the UK until February 2020. 
 
Link  December 2019: Shortages of HRT
   
Oestrogen only HRT gel (Oestrogel ®)
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Formulary
Red Hospital

 

  • CUHFT only.

 

  • Non formulary at all other trusts.

 

 
   
Oestrogens only HRT gel (Sandrena®)
(Gel estradiol 0.1%)
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Formulary
Green

 

  • Available as either 1g or 0.5g single dose sachets.

 

  • For menopausal symptoms, estradiol 1 mg (1 g gel) to be applied once daily over area 1–2 times size of hand.

 

  • Additional cyclical progestogen for 12–14 days of each cycle is recommended in women with a uterus.

 

  • Dose may be adjusted after 2–3 cycles to lowest effective dose (usual dose of estradiol 0.5–1.5 mg (0.5–1.5 g gel) daily)

 

  • Apply gel to intact areas of skin such as lower trunk or thighs, using right and left sides on alternate days.

 

  • Not to be applied on the breasts or face and avoid contact with eyes.

 

  • Allow area of application to dry for 5 minutes and do not wash area for at least 1 hour.

 

 

 

 
   
Tibolone (Livial®)
(Tablet)
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Restricted Drug Restricted
Advice

  • For patients one year post menopause who prefer not to have a regular bleed.

 
Link  MHRA information on breast cancer risks Feb 2009
   
06.04.01.01  Expand sub section  Ethinylestradiol
Ethinylestradiol
(Tablet )
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Restricted Drug Restricted
Amber No SCG

December 2019 - Shortages of ethinylestradiol 10mcg and 50mcg tablets 

  • UCB, sole supplier is out of stock due to manufacturing issues and currently unable to advise a resupply date.
 
   
06.04.01.01  Expand sub section  Raloxifene
Raloxifene Hydrochloride (Evista®)
(Tablet)
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Restricted Drug Restricted
Amber No SCG
  • For use in post menopausal women in line with NICE TAs 160 and 161.
  • See also C & P Osteoporosis Pathway.  
  • Link  C & P Osteoporosis Pathway (May 2016)
    Link  Drugs for osteoporosis (NICE TA160)
       
     ....
     Non Formulary Items
    Oestrogens for HRT  (Angeliq®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Bedol®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Climagest®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Climaval®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Climesse®)

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    Non Formulary
    Grey

    • Discontinued.

     
    Oestrogens for HRT  (Clinorette®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Cyclo-Progynova®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Elleste-Duet Conti®)
    (Tablet)

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    Non Formulary
    Grey

     

    • Same as Kliofem® which is formulary choice.



     
    Oestrogens for HRT  (Elleste-Solo® MX)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Estraderm MX®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Hormonin®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Indivina®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Novofem®)

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    Non Formulary
    Grey
     
    Oestrogens for HRT  (Nuvelle®)

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    Non Formulary
    Grey
    Tablet

     
    Oestrogens for HRT  (Ovestin®)

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    Non Formulary
    Grey
  • Intravaginal cream
  •  
    Oestrogens for HRT  (Progynova®)

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    Non Formulary
    Grey
    Tablet

    APC July 2011
     
    Oestrogens for HRT  (Progynova® TS)

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    Non Formulary
    Grey
    Patches

    APC July 2011
     
    Oestrogens for HRT  (Trisequens®)

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    Non Formulary
    Grey
     
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    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
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    OTC

    Available Over the Counter. Consider Self Care   

    Green

    Formulary - Can be prescribed in both secondary and primary care.   

    Advice

    Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

    Amber No SCG

    Formulary - Specialist initiation without shared care guidance.  

    Amber SCG

    Formulary - Specialist initiation with shared care guidance.  

    Red Hospital

    Restricted - Hospital only, not to be prescribed in primary care.  

    Switch

    Not recommended for prescribing. Switch to alternative cost-effective option.   

    Black

    Not recommended for prescribing in primary or secondary care.  

    Grey

    Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

    Non Formulary

    Non-Formulary (category under review).  

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