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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.
  • September 2019:
    • Shortage of Zumenon® 1mg - Mylan, the sole supplier, are experiencing supply issues. The 1mg strength is expected mid-September.  
    • 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. 
      • Premarin® (conjugated oestrogen) tablets (Pfizer) - Available to order via Alliance HC. 
      • Progynova® 1mg and 2mg tablets (Bayer) – Available to order via Alliance HC only.
 
   
Oestrogen only HRT patch
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Formulary
Green

 

  • Evorel® and Estradot® are the recommended brands for use in women without a uterus.
  • September 2019:
    • Availability of Evorel® patches - Janssen-Cilag has assured that these are available to order via Alliance HC and Phoenix. If pharmacies are having issues placing an order with their usual wholesaler, call Janssen-Cilag directly on 01494 567400. However, it is expected that the Evorel range will be out of stock in the Uk by the end of October until mid-2020. 
    • Supplies of Estradot® patches all strengths are filtering into Alliance and AAH on a weekly basis.



 

 
   
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.
  • September 2019:

    • Shortage of Femseven® Conti patches - Theramex the sole supplier are having issues with obtaining supply of a component of the patch and cannot advise on when Femseven® Conti patches will be available again.

    • Availability of Evorel® Conti patches - the other formulary choice is currently available from Janssen - Cilag. Janssen-Cilag has assured that these are available to order via Alliance HC and Phoenix. If pharmacies are having issues placing an order with their usual wholesaler, call Janssen-Cilag directly on 01494 567400. However, it is expected that the Evorel range will be out of stock in the Uk by the end of October until mid-2020. 

    • 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.




 

 
   
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.
 
   
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.
  • September 2019: 
    • Shortage of Femseven® Sequi patches - Theramex the sole supplier are having issues with obtaining supply of a component of the patch and cannot advise on when Femseven® Conti patches will be available again.
    • Availability of Evorel® Sequi patches- the other formulary choice is currently available from Janssen - Cilag. Janssen-Cilag has assured that these are available to order via Alliance HC and Phoenix. If pharmacies are having issues placing an order with their usual wholesaler, call Janssen-Cilag directly on 01494 567400. However, it is expected that the Evorel Sequi patches will be out of stock in the UK by the mid-September until mid-2020. 
    • 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.
 
   
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
 
   
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

    Green

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

    Green plus

    Available Over the Counter. Consider Self Care  

    Red Hospital

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

    Amber SCG

    Formulary - Specialist initiation with shared care guidance.  

    Amber No SCG

    Formulary - Specialist initiation without shared care guidance.  

    Advice

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

    Non Formulary

    Non-Formulary.  

    Black

    Non-Formulary - Not to be prescribed in primary or secondary care.  

    Grey

    Non-Formulary - No formal application made for addition to the formulary. Full Formulary Submission Application Form   

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