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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®)
        NICE TA863  Somatrogon [Engenla]                                                           
        Somatrogon is recommended, within its marketing authorisation, as an option for treating growth disturbance caused by 
        growth hormone eficiency in children and young people aged 3 years and over.
        If people with the condition and their clinicians consider somatrogon to be 1 of a range of suitable treatments (including 
        any preparation of somatropin) discuss the advantages and disadvantages of the available treatments. After that discussion, if 
        more than 1 treatment is suitable, choose the leastexpensive. Take account of administration costs, dosage, price per dose 
        and commercial arrangements.
        RED            Sonatrogon (Engenla®)                                                                                     ICB Commissioned, Blueteq required

   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
         Tolvaptan for the treatment of hyponatremia in adults, secondary to the syndrome of inappropriate antidiuretic hormone 
         secretion, for patients NOT requiring chemotherapy. Only if:
                >  treatment is initiated, titrated and monitored in hospital, by a specialist experienced in the treatment of SIADH, and
                >  fluid restriction has been unsuccessful or is inappropriate, and
                >  treatment  with demeclocycline has been unsuccessful or is inappropriate.
         RED           Tolvaptan (Samsca®)                                                                                   CCG Commissioned
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