Greater Glasgow and Clyde Medicines

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

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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:

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

Breast cancer

• As monotherapy for the treatment of adult patients with unresectable or metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer who have received one or more prior anti-HER2-based regimens.
• As monotherapy for the treatment of adult patients with unresectable or metastatic HER2-low breast cancer who have received prior chemotherapy in the metastatic setting or developed disease recurrence during or within 6 months of completing adjuvant chemotherapy.

Prescribing Notes:

Trastuzumab deruxtecan is currently non-formulary for the following indications:

• Gastric or gastroesophageal junction adenocarcinoma: As monotherapy for the treatment of adult patients with advanced HER2-positive gastric or gastroesophageal junction (GEJ) adenocarcinoma who have received a prior trastuzumab-based regimen.
• Non-small cell lung cancer: As monotherapy for the treatment of adult patients with advanced non-small cell lung cancer (NSCLC) whose tumours have an activating HER2 (ERBB2) mutation and who require systemic therapy following platinum-based chemotherapy with or without immunotherapy.
• Breast cancer: Treatment of adult patients with unresectable or metastatic hormone receptor (HR)-positive, HER2-low or HER2-ultra low breast cancer who have received at least one endocrine therapy in the metastatic setting and who are not considered suitable for endocrine therapy as the next line of treatment.
• Treatment of adult patients with unresectable or metastatic HER2-positive (IHC3+) solid tumours who have received prior treatment or who have no satisfactory alternative treatment options.

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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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Prescribing Notes:

In April 2014, following a Europe-wide review, the MHRA issued advice to healthcare professionals relating to the use of domperidone, restricting its use to relief of nausea and vomiting, advising that it should be used at the lowest effective dose for the shortest possible time, and highlighting changes to the contraindications, dosing and duration of treatment of the medicine.

The full advice from the MHRA can be accessed here.

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