|Therapeutic Area||Formulary Choices||Cost for 28|
(unless otherwise stated)
|Rationale for decision / comments|
|6.4.2 Male sex hormones and antagonists|
|First-line:||Sustanon 250®||250mg/ml amp: £2.45 (1ml)||Sustanon 250® is the testosterone injection of choice on grounds of cost-effectiveness|
|Second-line:||Testosterone Enantate||250mg/ml amp: £72.50 (3)|| is Testosterone Enantate 250mg given every 4 weeks. Trough testosterone should be measured on the day of the 3rd Enantate injection to make sure patients are not being overdosed – target is a testosterone in the lower quartile of reference range, 8-13 nmol/l.
The Enantate dosing interval range of 3-6 weekly is longer than that for Sustanon®, which is usually 3-4 weekly.
|Third-line:||Nebido®||250mg/ml amp: £87.11 (4ml)||If neither first- or second-line choices are available Nebido® injection lasts for 10-14 weeks - measuring trough testosterone weekly from 10 weeks will enable the dosing interval to be determined using the target range above.
Nebido® should be given with the patient lying in prone position
(Temporary formulary inclusion)
|Testogel®||16.2mg/g 88g pump: £31.11||ALL Testosterone products are included in the formulary for the duration of the national shortage of injectable formulations.
For non-injectable alternatives please see BNF 62 6.4.2 or Choosing a Testosterone Preparation information sheet for details.
|Tostran®||2% gel (10mg per application): £28.67 (60g)|
|Striant SR®||30mg Mucoadhesive buccal tablets: £28.00 (60)|
|Restandol®||40mg capsules: £8.55 (30)
|5-Alpha Reductase Inhibitors (5-ARIs)||Cross refer to section 7.4.1 for further details on the management of Lower Urinary Tract Symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), for which 5-ARIs are indicated.|
|Finasteride||5mg tablets: £1.12 (28)||Finasteride is the only recommended 5-ARI, due to the weight of clinical evidence and cost-effectiveness.
Dutasteride (Avodart®) is non-formulary following rejection by the T&ST D&TC