Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
8. Malignant disease and immunosuppression

8.3. Sex hormones and hormone antagonists in malignant disease

Total Formulary
Specialist Only
RADIUM-223 DICHLORIDE (XOFIGO) (injection)

Restrictions: The treatment of adults with castration-resistant prostate cancer, symptomatic bone metastases and no known visceral metastases is restricted to specialist use in accordance with regional protocol (in development) when the service infrastructure is in place to support the safe delivery of this treatment.

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8.3.1. Oestrogens

Total Formulary
Specialist and GP
DIETHYLSTILBESTROL

Restrictions: Restricted to specialist initiation.

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8.3.2. Progestogens

Total Formulary
Specialist Only
PROGESTERONE

Restrictions:

Use of Lubion® injection is restricted to women who are unable to use or tolerate vaginal preparations.

Prescribing Notes:

Use for luteal support as part of an assisted reproductive technology (ART) treatment program for infertile women is restricted to specialist use only in line with national guidance.  

BNF Link

Specialist and GP
MEGESTROL

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
MEDROXYPROGESTERONE

Restrictions: Restricted to specialist initiation.

BNF Link

NORETHISTERONE

8.3.3. Androgens

8.3.4. Hormone antagonists

8.3.4.1. Breast cancer

Total Formulary
Specialist and GP
TRIPTORELIN (Decapeptyl SR) (injection)

Restrictions:

Use in combination with tamoxifen or an aromatase inhibitor, for adjuvant treatment of endocrine responsive early stage breast cancer in women at high risk of recurrence who are confirmed as pre-menopausal after completion of chemotherapy is restricted to specialist initiation in accordance with regional protocol (in development).

Prescribing Notes:

For other indications for triptorelin, see sections 6.7.2 and 8.3.4.2

BNF Link

Specialist Only
FULVESTRANT (FASLODEX) (injection)

Restrictions:

Restricted to specialist use in accordance with regional protocol for the treatment of postmenopausal women with oestrogen receptor positive, locally advanced or metastatic breast cancer for disease relapse on or after adjuvant anti-oestrogen therapy, or disease progression on therapy with an anti-oestrogen.

Prescribing Notes:

The following indication is not recommended by SMC and remains non-Formulary:

  • Treatment of oestrogen receptor positive, locally advanced or metastatic breast cancer in postmenopausal women not previously treated with endocrine therapy

BNF Link

Specialist and GP
TAMOXIFEN

Restrictions: Restricted to specialist initiation.

Prescribing Notes:

Excludes tamoxifen liquid.

BNF Link

Specialist and GP
LETROZOLE

Restrictions: Restricted to specialist initiation. Restricted to use on the advice of breast cancer specialists in accordance with regional protocols.

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Specialist and GP
GOSERELIN

Restrictions:

For the management of advanced breast cancer (in pre- and peri- menopausal women), goserelin (but not Zoladex LA®) is approved where other treatments have failed.

Prescribing Notes:

For other indications, see sections 6.7.2 and 8.3.4.2

BNF Link

Specialist and GP
EXEMESTANE

Restrictions: Restricted to specialist initiation. Restricted to use on the advice of breast cancer specialists in accordance with regional protocols.

BNF Link

Specialist and GP
ANASTROZOLE

Restrictions: Restricted to specialist initiation. Restricted to use on the advice of breast cancer specialists in accordance with regional protocols.

BNF Link

8.3.4.2. Gonadorelin analogues and gonadotrophin-releasing hormone antagonists

Total Formulary
Specialist and GP
LEUPRORELIN (Prostap)

Restrictions: Restricted to specialist initiation.

Prescribing Notes:

  • Prostap® is the first line LHRH agonist for new patients with prostate cancer based on regional recommendations following the development of a national consensus statement.
  • Prostap® is available in two different presentations; Prostap® 3 DCS and Prostap® SR DCS, which have different frequencies of administration and as such, should be prescribed by brand name clearly specifying the preparation to avoid confusion.
  • Please note, although other brands of leuprorelin are available, the regional recommendation relates to Prostap® only

BNF Link

Specialist Only
ENZALUTAMIDE (soft capsules)

Restrictions:

Restricted to use in accordance with regional protocol for metastatic castration resistant prostate cancer (mCRPC).

Prescribing Notes:

The Regional Protocol for metastatic castration resistant prostate cancer (mCRPC) can be accessed here (NHS network access required).

Non- formulary indication:

  • Treatment of adult men with high-risk non-metastatic castration-resistant prostate cancer (CRPC) is not recommended by SMC

BNF Link

Specialist Only
ABIRATERONE ACETATE (tablets)

Restrictions:

Restricted to specialist use in accordance with regional protocol for the indications as outlined below.

Metastatic castration resistant prostate cancer (mCRPC):

  • Use in adult men in whom chemotherapy is not yet clinically indicated after failure of androgen deprivation therapy according to regional protocol 
  • Use in adult men who have received only one prior chemotherapy regimen (The Regional Protocol can be accessed here - NHS network access required)
  • With prednisone or prednisolone for the treatment of newly diagnosed high-risk metastatic hormone sensitive prostate cancer in adult men in combination with androgen deprivation therapy. Click here for regional protocol (NHS network access required)

Prescribing Notes:

 

BNF Link

Specialist and GP
DEGARELIX (FIRMAGON)

Restrictions: The treatment of adult male patients with advanced hormone-dependent prostate cancer is restricted to specialist initiation in accordance with regional protocol.

Prescribing Notes:

For the relevant SMC advice click here

BNF Link

Specialist and GP
HISTRELIN ACETATE (VANTAS) (Subcutaneous implant)

Restrictions: Restricted to use for the palliative treatment of advanced prostate cancer in accordance with the relevant Clinical Management Guideline

Prescribing Notes:

For the relevant SMC advice click here

BNF Link

Specialist and GP
GOSERELIN

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
FLUTAMIDE

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
CYPROTERONE

Restrictions: Restricted to specialist initiation. Owing to the risk of hepatotoxicity, cyproterone should be used for long-term treatment only where other treatments are not tolerated.

BNF Link

Specialist and GP
BICALUTAMIDE

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
AMINOGLUTETHIMIDE

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
TRIPTORELIN

Restrictions:

Prostate cancer

  • Decapeptyl SR 11.25mg is restricted for treatment of advanced prostate cancer in patients for whom the use of triptorelin is appropriate and would benefit from reduced frequency of administration compared with Decapeptyl SR 3mg. 
  • Triptorelin 22.5mg injection (Decapeptyl SR) for the treatment of locally advanced, non-metastatic or metastatic prostate cancer should be in accordance with Regional Protocol. 

Prescribing Notes:

For other indications for triptorelin, see section 6.7.2 and 8.3.4.1

Non-formulary indication:

  • Gonapeptyl Depot has not been recommended by SMC for the treatment of advanced prostate cancer

Note: This Formulary entry relates to triptorelin acetate and triptorelin pamoate.  Triptorelin embonate is not indicated for prostate cancer and is not included in the GGC Formulary.  Care should be taken to ensure the correct triptorelin preparation is prescribed and dispensed.

BNF Link

8.3.4.3. Somatostatin analogues

Total Formulary
Specialist Only
PASIREOTIDE (SIGNIFOR) (injection)

Restrictions:

Restricted to specialist use for the treatment of adults with acromegaly for whom surgery is not an option is has been curative and who are inadequately controlled on treatment with another somatostatin analogue.

Prescribing Notes:

Pasireotide is non-Formulary for the treatment of Cushing's disease in adults for whom surgery is not an option or where surgery has failed (not recommended for use in NHSScotland).

BNF Link

Specialist and GP
LANREOTIDE (AUTOGEL)

Restrictions: Restricted to specialist initiation. The use in the treatment of thyrotrophic adenomas is non-Formulary.

BNF Link

Specialist and GP
OCTREOTIDE

Restrictions: Restricted to specialist initiation.

BNF Link