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6.7 Other endocrine drugs

6.7 Other endocrine drugs

     6.7.1. Bromocriptine and other dopaminergic drugs
        First line
        AMBER     Cabergoline tablets 500 microgram
       Second line
       AMBER     Bromocriptine tablets 2.5mg
     6.7.2. Drugs affecting gonadotrophins
        Danazol has been discontinued - available as an unlicensed special
        Danazol combines androgenic, antioestrogenic and antiprogestogenic activity
        RED         Danazol capsules 100mg, 200mg [unlicensed special] 
       Gonadorelin analogues:-
       Goserelin and leuprorelin are recommended for use within their licensed indications, with goserelin recommended as the first 
       line product. Any unlicensed uses (e.g. precocious puberty) should not be transferred to primary care prescribers –prescribing 
       should be retained by secondary care.  There are two shared care protocols in place for the use of goserelin (the preferred 
       LHRH analogue).  One covers the use in gynaecology, the other covers the use in oncology settings (breast & prostate cancer), 
       and they can be accessed online at www.elmmb.nhs.uk/shared-care .

      First Line
      AMBER with SHARED CARE     Goserelin injection 3.6mg, 10.8mg    
      Second Line
      AMBER with SHARED CARE     Leuprorelin injection 3.75mg, 11.25mg
      (currently no shared care protocols exist for the use of leuprorelin locally as it is a second line agent)
      RED      Triptorelin SR 3mg
      (currently no shared care guideline available for triptorelin) 
      Specialist initiation only. For use in patients with locally advanced, non-metastatic prostate cancer, as an alternative to surgical 

     Moderate to severe symptoms of uterine fibroids
     Relugolix-estradiol-norithisterone acetate - for treating moderate to severe symptoms of uterine fibroids in adults of 
     reproductive age is recommended, within its marketing authorisation as an option in NICE TA832
     AMBER   Relugolix-estradiol–norethisterone acetate [Ryeqo]                                                            ICB Commissioned
     6.7.3 Other endocrine drugs

      Management of Cushing's Syndrome (specialist supervision in hospital) 
      RED                 Metyrapone capsules 250mg
      Management of foot ulcers in the diabetic population
      RED                 VACOcast Diabetic Boot
      To be initiated by specialist and prescribing retained within secondary care.
      All patients should be under the care of a diabetic foot team. The appropriate point of supply for the VACOcast Diabetic Boot
      is this specialist service. The VACOcast Diabetic Boot is recommended for the management of foot ulcers in the diabetic 
      population where a total contact cast is contra-indicated (presence of infection/ ischaemia / daily inspection required),not 
      tolerated or until  casting can be provided (NICE NG19).
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