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Other - Cost: £652,109,405.62 Empagliflozin (Jardiance) - Cost: £7,788,101.39 Edoxaban (Lixiana) - Cost: £8,056,980.75 Influenza vaccine (Fluad) - Cost: £13,930,057.90 Beclometasone / Formoterol MDI (Fostair) - Cost: £17,160,087.08 Rivaroxaban (Xarelto) - Cost: £20,491,468.20 Apixaban (Eliquis) - Cost: £33,811,997.20
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Notes for: Prostate Cancer & Gonadorelin Analogues
Last edited [26/09/2016 10:20:26]

1. Triptorelin (Decapeptyl®) is the preferred first choice GnRH analogue where appropriate for newly diagnosed patients.

2. Goserelin (Zoladex®) is included as neoadjuvant or adjuvant treatment in prostate cancer and as a second line alternative being the only licensed product for use in the treatment of breast cancer and IVF.

3. Given the emotive clinical indications this therapy is used to treat there is no compulsion at present to change existing patients' therapy or agreed treatment regimens. Local specialists agree that all GnRH analogues are equally effective and will continue to recommend treatment with a 'GnRH analogue' rather than a specific brand of product to be used unless clinically indicated. Specialists agree that general practitioners can change the product prescribed within this class of therapy to complete courses of therapy for existing patients as clinically appropriate and after informed discussions with the patient.

4. Flutamide is given to counter tumour flare with initial gonadorelin therapy. Used for up to 3 weeks in patients with symptomatic and advanced prostatic carcinoma only.

5. HEPATOTOXICITY. Direct hepatic toxicity including jaundice, hepatitis and hepatic failure has been reported (usually after several months) in patients treated with cyproterone acetate 200 - 300 mg daily. Liver function tests should be performed before treatment and whenever symptoms suggestive of hepatotoxicity occur - if confirmed cyproterone should normally be withdrawn. Cyproterone is no longer recommended for long term use.

6. Bicalutamide is the only anti-androgen licensed as a single agent for monotherapy in a patient with locally advanced disease. The dosage of bicalutamide is 150 mg OD as a single agent, or 50 mg OD when given in conjunction with gonadorelin analogue injection therapy. Care should be taken to ensure correct choice of dose.

 

Cornwall Joint Formulary Recommended Choices     (...Top)
Displaying 14 Drugs

Key:
First Line Drugs First Line Drugs
Second Line Drugs Second Line Drugs
Specialist Initiated Drugs Specialist Initiated Drugs
Hospital Only Drugs Hospital Only Drugs
Discouraged Discouraged
No comment available No comment available
Antibiotics Antibiotics

NameTariffBNF Sub Paragraph
Bicalutamide
50 mg tab Pack of 28
£2.77PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Bicalutamide'View SPC on 'Bicalutamide'View PIL on 'Bicalutamide'
Bicalutamide
150 mg tab Pack of 28
£4.55PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Bicalutamide'View SPC on 'Bicalutamide'View PIL on 'Bicalutamide'
Cyproterone Acetate
50 mg tab Pack of 56
£38.27PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Cyproterone Acetate'View SPC on 'Cyproterone Acetate'View PIL on 'Cyproterone Acetate'
Triptorelin (Decapeptyl)
3 mg SR vial Pack of 1
£69.00PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Triptorelin'View SPC on 'Triptorelin'View PIL on 'Triptorelin'
Goserelin Implant (Zoladex Safe System)
3.6 mg depot injection Pack of 1
£70.00PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Goserelin Implant'View SPC on 'Goserelin Implant'View PIL on 'Goserelin Implant'
Cyproterone Acetate
100 mg tab Pack of 84
£72.95PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Cyproterone Acetate'View SPC on 'Cyproterone Acetate'View PIL on 'Cyproterone Acetate'
Flutamide
250 mg tab Pack of 84
£106.23PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Flutamide'View SPC on 'Flutamide'View PIL on 'Flutamide'
Degarelix (Firmagon)
80 mg powder and solvent for solution for injection vials Pack of 1
£129.37PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Degarelix'View SPC on 'Degarelix'View PIL on 'Degarelix'
Triptorelin (Decapeptyl)
11.25 mg SR vial Pack of 1
£207.00PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Triptorelin'View SPC on 'Triptorelin'View PIL on 'Triptorelin'
Leuprorelin Injection (Prostap 3)
11.25 mg dual chamber syringe (DCS) Pack of 1
£225.72PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Leuprorelin Injection'View SPC on 'Leuprorelin Injection'View PIL on 'Leuprorelin Injection'
Goserelin Implant (Zoladex Safe System)
10.8 mg depot injection Pack of 1
£235.00PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Goserelin Implant'View SPC on 'Goserelin Implant'View PIL on 'Goserelin Implant'
Degarelix (Firmagon)
120 mg powder and solvent for solution for injection vials 2 vials Pack of 2
£260.00PCT FORMULARY STATUS: Specialist Initiated Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Degarelix'View SPC on 'Degarelix'View PIL on 'Degarelix'
Triptorelin (Decapeptyl)
22.5 mg SR vial Pack of 1
£414.00PCT FORMULARY STATUS: Specialist Initiated Drugs [Notes:] Following specialist initiation, patients can be switched to the 6 monthly preparation by the GP Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Triptorelin'View SPC on 'Triptorelin'View PIL on 'Triptorelin'
Following specialist initiation, patients can be switched to the 6 monthly preparation by the GP
Abiraterone (Zytiga)
250 mg tab Pack of 120
- PCT FORMULARY STATUS: Hospital Only Drugs Prostate Cancer & Gonadorelin AnaloguesView BNF Article on 'Abiraterone'View SPC on 'Abiraterone'View PIL on 'Abiraterone'

 
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