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6.5 Hypothalamic and pituitary hormones and anti-oestrogens


6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens

Clomifene citrate tablets - Specialist use only
Letrozole tablets - see also note below
Somatropin injection - click here for shared care


NICE TA64: Adults with growth hormone deficiency

NICE TA188: Children with growth hormone deficiency

Tetracosactide injection, depot injection
Chorionic gonadotrophin injection
Follitropin alfa (Gonal-F) injection
Follitropin alfa (Bemfola) injection
Menotrophin injection
Urofollitropin injection
Thyrotropin alfa (rhTSH - Thyrogen) injection - for the detection of thyroid remnants and thyroid cancer in post thyroidectomy patients and to increase I131 uptake for ablation of thyroid remnant tissue in post thyroidectomy patients.
Gonadorelin injection
Protirelin injection


CSM ADVICE: clomifene  should not normally be used for longer than 6 cycles (possible risk of ovarian cancer in patients treated for longer than recommended).

Letrozole is used by Fertility services for ovulation induction in subfertile women (unlicensed indication), as an alternative to clomifene.

6.5.2 Posterior pituitary hormones and antagonists    

Desmopressin nasal spray, injection, tablets - see note
Terlipressin injection
Tolvaptan tablets (for autosomal dominant polycystic kidney disease – see NICE TA 358)
Vasopressin injection


1.There is a significant risk of severe harm or death when desmopressin (in any form) is omitted or delayed in patients with cranial diabetes insipidus. See Patient Safety Alert from NHSE.

2. Terlipressin is also included for treatment of hepato-renal syndrome by specialist only).


For link to BNF section: 6.5 Hypothalamic and pituitary hormones and anti-oestrogens