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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 6 - Endocrine system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
06.02.01 Thyroid hormones

Levothyroxine
(Oral)

GREEN
Formulary
25microgram, 50microgram & 100microgram Tablets
BNF BNFc SPC
MHRA DSU Oct 2018: Ritonavir-containing products: reports of interaction with levothyroxine leading to reduced thyroxine levels

Levothyroxine 50micrograms/ 5mL
(Oral solution)

GREEN
Formulary

BNF BNFc SPC

Liothyronine
(Injection)

RED
Restricted Drug Restricted
20microgram Injection

Only to be used for it's licensed indication: myxoedema coma.
N.B. cost now £1710 per 5 ampoules.

Levothyroxine has a very long half life (~7 days) so temporary IV replacement if NBM is not needed unless prolonged. Unlicensed IV levothyroxine is now available for this indication.
BNF BNFc SPC
JPC: Position Statement – High Cost Drugs Excluded from the National Tariff – Liothyronine Injection

Liothyronine (oral)

 
Restricted Drug Restricted

Prescribing is restricted to certain patient groups for specific indications - please refer to the NHSE Guidance for restricted prescribing criteria. 

Cost effective preparations to be advised via OptimiseRx. 

Enolio® (liothyronine 10mcg/ml oral solution) is a cost-effective option. It is free from ethanol, gelatine, lactose, starch and sodium and licensed for use via enteral feeding tubes.

Amber SPIS For hypothyroid indication - see NHSE guidance for restrictions on initiation

Red For oncology and psychiatry indications

 

Entry reviewed: July 2025

BNF BNFc SPC
NHSE Liothyronine – advice for prescribers

Levothyroxine
(injection)

RED
Restricted Drug Restricted

unlicensedunlicensed. 200micrograms/ml injection.

Please note this is a different brand to the one listed in the Medusa IVGUIDE. Follow the attached dose conversion  and administration guide.


Restricted: for patients who are NBM for a prolonged period. Half-life is very long (about 7 days) so replacement is often not needed in the short-term.
To be prescribed on the recommendation of a consultant endocrinologist only.

BNF BNFc SPC
MHRA DSU Oct 2018: Ritonavir-containing products: reports of interaction with levothyroxine leading to reduced thyroxine levels IV Levothyroxine - Dose Conversion & Administration Guide
Non formulary items

Desiccated (natural) thyroid extract products (Armour Thyroid, Westhroid, Nature-Throid, Erfa))

DNP
Non Formulary

Desiccated (natural) thyroid extract (DTE) products are not licensed in the UK, which means their efficacy, safety, consistency and quality cannot be assured.

Prescribers in primary care should not initiate DTE and should explain the clinical concerns to patients who ask about it. See SPS evidence review (link below)

Using desiccated (natural) thyroid extract products for hypothyroidism

Entry reviewed: May 2025

BNF BNFc SPC
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.