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Decisions 10th December 2024
The following decisions were made at the Joint Formulary Group meeting held on Tuesday 10th December:
New Drug Requests
Testosterone gel for low libido in post-menopausal women (Amber 3 months)
Application to widen the cohort was approved. Use of testosterone gel is no longer limited to women with either (a) early menopause (45 years and under) or (b) surgical menopause (bilateral oophorectomy). The criteria for use of testosterone gel for this indication is as follows:
- libido causing distress and
- Ongoing symptoms despite optimised oestrogen and progesterone HRT and
- All other causes (biopsychosocial approach) have been excluded and
- total testosterone <1.5nmol/L.
Other decision relating to Testosterone gel
The Joint Formulary Group approved the introduction of a “menopause specialist” to allow the initiation of testosterone one gel in primary care by a qualified menopause specialist.
A specialist in menopause for the purposes of testosterone prescribing is: a British Menopause Society accredited specialist or equivalent prescriber who can demonstrate that they have received training in, and have clinical experience of, treating women with testosterone preparations. This could therefore be a GP or ANP or Pharmacist Independent Prescriber working in primary care if they meet the following criteria:
- A healthcare professional who holds a recognised menopause qualification such as:
- BMS Management of the Menopause Certificate
- FSRH Menopause Care Professional Certificate (MCPC)
and
- Maintains skills and knowledge in line with GMC / NMC / GPhC requirements for revalidation
- To be a prescriber with knowledge of the drug regimens and side effects
- Attends a national or regional menopause scientific update session at least once every three years (e.g. BMS, FSRH, primary care forum, etc);
- Provides a minimum of 100 menopause related consultations per year, of which at least 50 are new.
Traffic Light Status Changes
Prasugrel – TLS changed from Amber One Month to Amber Specialist Initiated. The shared care protocol for prasugrel has been removed.
Ticagrelor - TLS changed from Amber One Month to Amber Specialist Initiated. The shared care protocol for ticagrelor has been removed.
Famotidine and Nizatadine – TLS changed from green to blue.
Other Decisions
Budesonide suppositories (TLS Blue)
Mesalazine - discussions were held about a suitable monitoring schedule and traffic light status. Further work is ongoing.
Methotrexate (Dermatology) shared care protocol – minor update to formulations covered by SCP to include oral and subcutaneous injections.
Levobunolol 0.5% eye drops have been discontinued and removed from the Formulary.