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South Staffordshire Joint Formulary
Cannock Chase Clinical Commissioning Group
East Staffordshire Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
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 Formulary Chapter 6: Endocrine system - Full Chapter
06.01.02.03  Expand sub section  Other antidiabetic drugs
Nateglinide (Starlix®)
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Formulary
Green
 
   
Pioglitazone (Actos®)
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Formulary
Green
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
 
   
Repaglinide (Prandin®)
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Formulary
Green
 
   
06.01.02.03  Expand sub section  DPP-4 inhibitors
Alogliptin (Vipidia®)
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Formulary
Green

Maximal effect is seen in 3-6 months; if no response to therapy in 6 months in terms of achieving patients target then review

 
   
Linagliptin (Trajenta®)
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Formulary
Green
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
 
   
Sitagliptin (Januvia®)
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Formulary
Green
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. 
   
06.01.02.03  Expand sub section  GLP-1 mimetics
DulaglutideBlack Triangle (Trulicity®)
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Formulary
Amber

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

 
   
Exenatide (Byetta®)
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Formulary
Amber
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
 
   
Liraglutide (Victoza®)
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Formulary
Amber

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

 
Link  NICE NG28: Type 2 diabetes in adults:management
   
Lixisenatide (Lyxumia®)
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Formulary
Red
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
 
   
SemaglutideBlack Triangle (Ozempic®)
(Once weekly GLP 1)
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Formulary
Amber

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

 
Link  NICE NG28: Type 2 diabetes in adults:management
   
Exenatide (Bydureon®)
(Once weekly GLP1 )
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Formulary
Amber

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

 
   
06.01.02.03  Expand sub section  SGLT2 inhibitors
 note 

SGLT2 inhibitors: Reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum).

Canagliflozin (Invokana®)
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Formulary
Green
 
Link  NICE TA315: Canagliflozin in combination therapy for treating type 2 diabetes
Link  NICE TA390 - Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
   
Dapagliflozin (Forxiga®)
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Formulary
Green

Restriction: In line with NICE Guidance only

 
Link  NICE TA 288: Dapagliflozin in combination therapy for treating type 2 diabetes
Link  NICE TA390 : Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
Link  NICE TA418: Dapagliflozin in triple therapy for treating type 2 diabetes
   
Dapagliflozin (Forxiga® )
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Formulary
Red

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

 
Link  TA597: Dapagliflozin with insulin for treating type 1 diabetes
   
Empagliflozin (Jardiance)
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Formulary
Green
 
Link  NICE TA336 : Empagliflozin in combination therapy for treating type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies fortreating type 2 diabetes
   
ErtugliflozinBlack Triangle (Steglatro®)
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Formulary
Green

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)

 
Link  NICE TA572: Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes
Link  NICE TA583: Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes
Link  SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
   
 ....
 Non Formulary Items
Acarbose  (Glucobay®)

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Non Formulary
 
Alogliptin / metformin  (Vipdomet®)

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Non Formulary
 
Alogliptin / pioglitazone  (Incresync®)

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Non Formulary
 
Dapagliflozin / metformin  (Xigduo®)

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Non Formulary
 
Rosiglitazone  (Avandia®)

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Non Formulary
 
Rosiglitazone and Metformin  (Avandamet®)

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Non Formulary
 
Saxagliptin and metformin  (Komboglyze®)

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Non Formulary
 
Sitagliptin and Metformin  (Janumet®)

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Non Formulary
 
Vildagliptin

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs which require special consideration. These are drugs for Consultant Prescribing ONLY. They should not be prescribed in Primary Care.  

Amber

Drugs that should be initiated by a Specialist but are suitable for continuation in Primary Care. For some drugs there may be a Ricad in place to aid the transition to primary care.  

Amber E

Drugs that should be initiated by a Specialist but are suitable for continuation in Primary Care but also require and ESCA (Shared Care Agreement)   

Green

Suitable first-line drugs for implementation in Primary Care  

On Formulary

South Staffs Formulary Choice  

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