Greater Glasgow and Clyde Medicines

Restrictions:

Restricted to specialist use in accordance with regional protocol [NHS network access required] for the indication below:

• Use in combination with chlorambucil or bendamustine for the treatment of patients with chronic lymphocytic leukaemia (CLL) who have not received prior therapy and who are not eligible for fludarabine-based therapy in patients who would not be considered for bendamustine therapy and who would receive chlorambucil-based therapy.

Prescribing Notes:

The treatment of adults with relapsed CLL in combination with fludarabine and cyclophosphamide is not recommended by SMC and is non-Formulary.

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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 protocols [NHS network access required].

Prescribing Notes:

For other indications for triptorelin, see sections 6.7.2 and 8.3.4.2

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Restrictions:

The treatment of adult male patients with advanced hormone-dependent prostate cancer is restricted to specialist initiation in accordance with regional protocol [NHS network access required].

Prescribing Notes:

For the relevant SMC advice click here

BNF Link

Restrictions:

Restricted to specialist use only in accordance with regional protocols [NHS network access required] for:

• Treatment of high-risk localised and locally advanced hormone dependent prostate cancer in combination with radiotherapy.
• As neoadjuvant treatment prior to radiotherapy in patients with high-risk localised or locally advanced hormone dependent prostate cancer.

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Restrictions:

Use in the treatment of type 2 diabetes mellitus (T2DM) is restricted to initiation by clinicians, either in primary care or the acute setting, experienced in the treatment of diabetes for use in addition to other anti-diabetic medicines, or as an add-on to basal insulin. 

Prescribing Notes:

• Semaglutide is a biological medicine. Biological medicines must be prescribed and dispensed by brand name; the manufacturer advises to record the brand name and batch number after each administration.
• NHSGGC Diabetes Guidelines click here
• Please be aware of the MHRA warning about the potential for medication errors during the transition to new formulations for the medication click here. [December 2025]

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Restrictions:

Chronic Kidney Disease:

Restricted to initiation by clinicians, either in primary or secondary care, experienced in the treatment of chronic kidney disease (CKD) for use in patients having individually optimised standard care (including angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, unless these are contraindicated or not tolerated), and either, at the start of treatment:

• an estimated glomerular filtration rate (eGFR) of 20 mL/min/1.73m² up to 45 mL/min/1.73m², or
• an eGFR of 45 mL/min/1.73m² up to 90 mL/min/1.73m² and either:
  • A urine albumin-to-creatinine ratio (uACR) of 22.6 mg/mmol or more, or
  • Type 2 Diabetes Mellitus (T2DM). 

For use in chronic heart failure, see section 2.5.6

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Restrictions:

Type 2 diabetes mellitus:

Restricted to the treatment of type 2 diabetes in adult patients as:

• Monotherapy in adults for whom use of metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control only if a dipeptidyl peptidase-4 (DPP-4) inhibitor would otherwise be prescribed AND a sulfonylurea or pioglitazone is not appropriate
• Dual therapy in combination with metformin, when metformin alone with diet and exercise does not provide adequate glycaemic control and a sulfonylurea is inappropriate
• Triple therapy in combination with metformin and sulfonylurea, as an alternative to DPP-4 inhibitor
• In combination with insulin, when insulin with diet and exercise, does not provide adequate glycaemic control

Prescribing Notes:

NHSGGC Diabetes Guidelines click here

Please click hyperlinks for formulary information on use in chronic heart failure and chronic kidney disease.

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Restrictions:

Atopic dermatitis:

The use in the treatment of moderate-to-severe atopic dermatitis in adults is restricted to use in accordance with local guidelines in patients who have had an inadequate response to existing systemic immunosuppressants such as ciclosporin, or in whom such treatment is considered unsuitable.

Prurigo nodularis:

Treatment of adults with moderate-to-severe prurigo nodularis (PN) who are candidates for systemic therapy.

Prescribing Notes:

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

• Treatment of chronic spontaneous urticaria (CSU) in patients aged 12 years and older whose disease is not adequately controlled with H1 antihistamine treatment.

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Restrictions:

Restricted to specialist use in accordance with regional protocols [NHS network access required] for the following indications:

• Unresectable or metastatic BRAF V600 mutation-positive metastatic melanoma who have received no prior therapy.
• In combination with trametinib for the adjuvant treatment of adults with stage III melanoma with a BRAF V600 mutation following complete resection.
• In combination with trametinib for the treatment of adults with locally advanced or metastatic anaplastic thyroid cancer with evidence of a BRAF V600E mutation and with no satisfactory locoregional treatment options (as approved by NCMAG). 

Prescribing Notes:

The following indications are not recommended for use by the SMC and are non-Formulary:

• In combination with trametinib for the treatment of adults with advanced non-small cell lung cancer with BRAF V600 mutation.

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Restrictions:

Restricted to specialist use only.

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