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6.5 Hypothalamic and pituitary hormones and anti-oestrogens

6.5 Hypothalamic and pituitary hormones and anti-oestrogens

6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens

Clomifene is used in the treatment of female infertility. The gonadatrophins found in this section (but not listed) are only used by 
specialist centres who should retain all the prescribing – GPs should not be asked to prescribe.
RED           Clomifene tablets 50mg
RED           All gonadatrophins listed in section 6.5.1 of the BNF
RED           Human Chorionic Gonadotropin (Gonasi®) [unlicensed medicine, for use by endocrinolgoy only]
RED            Tetracosactide 250microgram injection  (Synacthen®)
RED           Tetracosactide 1mg depot injection (Synacthen depot®)
Growth hormone
In line with NICE guidelines for adults and children.
AMBER     Somatropin injection 
 (all brands included within section 6.5.1 of the BNF - Omnitrope is the least costly brand)
Growth hormone receptor antagonists
Only to be initiated and prescribed by tertiary referral centres
RED           Pegvisomant (Somavert®)

6.5.2 Posterior pituitary hormones and antagonists

Desmopressin is a synthetic analogue of vasopressin, and is indicated for treatment of primary nocturnal enuresis (PNE); nocturia
associated with multiple sclerosis when other treatments have failed; and diagnosis and treatment of vasopressin-sensitive cranial 
diabetes insipidus; it is also indicated for establishment of renal concentration capacity.
At the request of the MHRA, the indication for the treatment of primary nocturnal enuresis (PNE) has been removed from all 
desmopressin nasal spray products. Desmopressin nasal sprays remain available for the treatment of patients with cranial 
diabetes insipidus or nocturia associated with multiple sclerosis. In comparison with oral formulations of desmopressin, nasal 
forms were associated with the majority of serious adverse drug reactions (ADRs) reported in patients with PNE.
Rare, serious ADRs included hyponatraemia, water intoxication and convulsions. As the risk benefit profile of the oral formulations 
is more favourable than the nasal spray, the nasal form should no longer be used for the treatment of PNE in adults and children.
Treatment of primary nocturnal enuresis (PNE) 
GREEN      Desmopressin tablets 100, 200 microgram
                   oral lyphilisate 120microgram (Desmomelt®)    
                   NB- 120microgram melt is equivalent to 200 microgram oral tablet) 
BLACK      Nasal spray 10microgram/metered spray (see notes above) 
Used for diagnosis and treatment of pituitary diabetes insipidus 
GREEN      Desmopressin tablets 100, 200 microgram 
                  oral lyphilisate 120microgram (Desmomelt®)
                   (NB- 120microgram melt is equivalent to 200 microgram oral tablet) 
                   nasal spray 10microgram/metered spray (see notes above)  
RED           Desmopressin injection 4 microgram/mL  
Used for bleeding oesophageal varices
RED           Terlipressin injection 1mg
Used for treatment of hyponatraemia associated with inappropriate secretion of anti-diuretic hormone
RED     Demeclocycline 150mg capsules
Existing patients to be referred back to secondary care.
Autosomal dominant polycystic kidney disease 
NICE TA358  Tolvaptan recommended as an option for treating autosomal dominant polycystic kidney disease 

RED           Tolvaptan (Jinarc®)  
                  tablets 15mg, 30mg,45mg, 60mg, 90mg
Tolvaptan for treating SIADH in patients requiring cancer chemotherapy
Consultant prescribing only.
RED           Tolvaptan (Samsca®)                                               (NHS England Commissioned)  

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 public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service 
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