| Formulary Chapter 6: Endocrine system - Full Chapter
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| 06.01.02.03 |
Other antidiabetic drugs |
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Nateglinide (Starlix®)
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Formulary
 
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Pioglitazone (Actos®)
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Formulary
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Glitazones and Gliptins should only be considered if:
• Substituting for a sulphonylurea in patients on metformin and a sulphonylurea where there is a significant risk of hypoglycaemia (or its consequences) or a sulphonylurea is contra-indicated or not tolerated.
• Metformin is contraindicated or not tolerated and the patient HBA1c remains above 6.5% on a sulphonylurea.
As triple therapy if insulin is unacceptable (because of employment, social or recreational or other personal issues, or obesity.
Only continue if reduction in HBA1c of at least 0.5% in 6 months
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Repaglinide (Prandin®)
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Formulary
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| 06.01.02.03 |
DPP-4 inhibitors |
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Alogliptin (Vipidia®)
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Formulary
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Maximal effect is seen in 3-6 months; if no response to therapy in 6 months in terms of achieving patients target then review
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Linagliptin (Trajenta®)
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Formulary
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Glitazones and Gliptins should only be considered if:
• Substituting for a sulphonylurea in patients on metformin and a sulphonylurea where there is a significant risk of hypoglycaemia (or its consequences) or a sulphonylurea is contra-indicated or not tolerated.
• Metformin is contraindicated or not tolerated and the patient HBA1c remains above 6.5% on a sulphonylurea.
As triple therapy if insulin is unacceptable (because of employment, social or recreational or other personal issues, or obesity.
Only continue if reduction in HBA1c of at least 0.5% in 6 months
Maximal effect is seen in 3-6 months; if no response to therapy in 6 months in terms of achieving patients target then review
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Sitagliptin (Januvia®)
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Formulary
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Glitazones and Gliptins should only be considered if:
• Substituting for a sulphonylurea in patients on metformin and a sulphonylurea where there is a significant risk of hypoglycaemia (or its consequences) or a sulphonylurea is contra-indicated or not tolerated.
• Metformin is contraindicated or not tolerated and the patient HBA1c remains above 6.5% on a sulphonylurea.
As triple therapy if insulin is unacceptable (because of employment, social or recreational or other personal issues, or obesity.
Only continue if reduction in HBA1c of at least 0.5% in 6 months
Maximal effect is seen in 3-6 months; if no response to therapy in 6 months in terms of achieving patients target then review.
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| 06.01.02.03 |
GLP-1 mimetics |
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Dulaglutide (Trulicity®)
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Formulary
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To be initiated by a diabetes specialist
Once weekly GLP1 injection
0.75mg and 1.5mg solution for injection in a pre-filled pen
Not for monotherapy
Only continue if reduction in HBA1c of at least 1.0 percentage points and a weight loss of at least 3% is achieved within 6 months of starting treatment
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Exenatide (Byetta®)
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Formulary
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Exenatide should only be considered if
• BMI>= 35mg/m2 in people of European descent and there are problems associated with high weight
• BMI < 35mg/m2 and insulin is unacceptable because of occupational implications or weight loss would benefit other co-morbities.
Only continue if reduction in HBA1c of at least 1.0 percentage points and a weight loss of at least 3% is achieved within 6 months of starting treatment
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Liraglutide (Victoza®)
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Formulary
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THIS IS FOR DIABETES ONLY.
Exenatide should only be considered if
• BMI>= 35mg/m2 in people of European descent and there are problems associated with high weight
• BMI < 35mg/m2 and insulin is unacceptable because of occupational implications or weight loss would benefit other co-morbities.
Only continue if reduction in HBA1c of at least 1.0 percentage points and a weight loss of at least 3% is achieved within 6 months of starting treatment
Doses should not exceed 1.2mg
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 NICE NG28: Type 2 diabetes in adults:management
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Lixisenatide (Lyxumia®)
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Formulary
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Exenatide should only be considered if
• BMI>= 35mg/m2 in people of European descent and there are problems associated with high weight
• BMI < 35mg/m2 and insulin is unacceptable because of occupational implications or weight loss would benefit other co-morbities.
Only continue if reduction in HBA1c of at least 1.0 percentage points and a weight loss of at least 3% is achieved within 6 months of starting treatment
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Semaglutide (Ozempic®)
(Once weekly GLP 1)
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Formulary
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To be initiated by a diabetes specialist
Once weekly GLP1 injection
Ozempic 0.25mg, 0.5mg and 1mg solution for injection pre-filled pens
Only continue if reduction in HBA1c of at least 1.0 percentage points and a weight loss of at least 3% is achieved within 6 months of starting treatment
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NICE NG28: Type 2 diabetes in adults:management
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Exenatide (Bydureon®)
(Once weekly GLP1 )
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Formulary
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Bydureon 2 mg powder and solvent for prolonged-release suspension for injection pre-filled pen
PRODUCT DISCONTINUATION
Bydureon 2 mg powder and solvent for prolonged-release suspension for injection in pre-filled pen (exenatide once-weekly) will be discontinued from 31/12/2020. Clinicians should note that the old device is being replaced by the Bydureon BCise pen (exenatide 2mg prolonged-release injectable suspension); a once weekly, single use, fixed dose pen with a hidden needle that automatically injects the required dose, allowing for simpler administration compared to the old Bydureon device. Prior to prescribing and administration of this new device, patient and caregivers training must be undertaken by a healthcare professional.
To be initiated by a diabetes specialist
Once weekly preparation of exenatide
Exenatide should only be considered if
• BMI>= 35mg/m2 in people of European descent and there are problems associated with high weight
• BMI < 35mg/m2 and insulin is unacceptable because of occupational implications or weight loss would benefit other co-morbities.
Only continue if reduction in HBA1c of at least 1.0 percentage points and a weight loss of at least 3% is achieved within 6 months of starting treatment
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| 06.01.02.03 |
SGLT2 inhibitors |
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Canagliflozin (Invokana®)
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Formulary
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NICE TA315: Canagliflozin in combination therapy for treating type 2 diabetes
NICE TA390 - Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
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Dapagliflozin (Forxiga®)
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Formulary
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Restriction: In line with NICE Guidance only
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NICE TA 288: Dapagliflozin in combination therapy for treating type 2 diabetes
NICE TA390 : Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
NICE TA418: Dapagliflozin in triple therapy for treating type 2 diabetes
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Dapagliflozin (Forxiga® )
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Formulary
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Dapagliflozin Tablets 5mg
Restriction: as per NICE Guidance - Dapagliflozin with insulin for treating type 1 diabetes
Initiation and stabilisation by diabetic specialist and 6 month review to take place by the specialist
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TA597: Dapagliflozin with insulin for treating type 1 diabetes
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Empagliflozin (Jardiance)
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Formulary
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NICE TA336 : Empagliflozin in combination therapy for treating type 2 diabetes
NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies fortreating type 2 diabetes
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Ertugliflozin (Steglatro®)
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Formulary
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Ertugliflozin Tablets 5mg
Ertugliflozin Tablets 15mg
Restriction: In line with NICE Guidance only
For mono, dual & triple therapy - should not be initiated in patients with a glomerular filtration rate [GFR] < 60 mL/min and should be discontinued at GFR persistently below 45 mL/min
MHRA/CHM advice (updated April 2016): Risk of diabetic ketoacidosis with sodium-glucose co-transporter 2 (SGLT2) inhibitors
MHRA/CHM advice: SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) (February 2019)
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NICE TA572: Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes
NICE TA583: Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes
SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
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| Non Formulary Items |
Acarbose (Glucobay®)
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Non Formulary
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Alogliptin / metformin (Vipdomet®)
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Non Formulary
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Alogliptin / pioglitazone (Incresync®)
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Non Formulary
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Dapagliflozin / metformin (Xigduo®)
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Non Formulary
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Rosiglitazone (Avandia®)
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Non Formulary
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Rosiglitazone and Metformin (Avandamet®)
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Non Formulary
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Saxagliptin and metformin (Komboglyze®)
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Non Formulary
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Sitagliptin and Metformin (Janumet®)
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Non Formulary
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Vildagliptin
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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