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]

Corticotrophins

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

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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