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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:

Diabetes Guidelines

 Details...
06.01.02.03  Expand sub section  Other antidiabetic drugs
06.01.02.03  Expand sub section  Alpha glucosidase inhibitors
06.01.02.03  Expand sub section  DPP4 inhibitors (gliptins)
Alogliptin (Vipidia▼)
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First Choice
Green

First line DPP4.

Use within NICE recommendations: continue only if HbA1c is reduced by at least 0.5%within six months of starting treatment

 
Linagliptin (Trajenta▼)
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Formulary
Green

Use within NICE recommendations

Continue only if HbA1c is reduced by at least 0.5%within six months of starting treatment

 
   
Saxagliptin (Onglyza)
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Formulary
Green

Use within NICE recommendations

Continue only if HbA1cis reduced by at least 0.5%within six months of starting treatment

 
   
Sitagliptin (Januvia)
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Formulary
Green

Use within NICE recommendations

Continue only if HbA1cis reduced by at least 0.5%within six months of starting treatment

 
   
06.01.02.03  Expand sub section  GLP1 agonists
Semaglutide (Ozempic)
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First Choice
Amber

Semaglutide is the product of choice when a once weekly GLP-1 agonist is to be used.  

NB multidose pen delivers 4 doses ie one pen = one month supply.

Initiation dose 0.25mg once a week, then 0.5mg once a week.

When administration is with insulin: In line with NICE NG28, DSN initaition advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.  Also; in line with the SPC, caution should be exercised when considering use in patients with diabetic retinopathy treated with insulin.

 
Dulaglutide (Trulicity)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

Accepted onto formulary (Apr 2016) as a once weekly preparation in line with NICE NG28 type 2 diabetes guidance for patients who:

•have a BMI of 35 kg/m2 or higher (adjust accordingly for people from black, Asian and other minority ethnic groups) and specific psychological or other medical problems associated with obesity or

•have a BMI lower than 35 kg/m2 and:

◦for whom insulin therapy would have significant occupational implications or

◦weight loss would benefit other significant obesity-related comorbidities. [new 2015]

 

 
   
Exenatide (Byetta▼)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

NICE recommendation: Consider adding exenatide to metformin and a sulphonylurea if:

 BMI > 35kg/m2 in those of European descent with adjustment for other ethnic groups, and specific psychological or medical problems associated with high body weight

 A BMI > 35kg/m2 and for whom initiation of insulin therapy would have significant occupational implications, or where weight loss would benefit other significant comorbidities

 
   
Exenatide prolonged release (Bydureon▼)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

Once weekly preparation NICE TA248

Consider adding prolonged-release exenatide to metformin and either a sulphonylurea or a thiazolidinedione if blood glucose levels are not under control, and:

 BMI of 35 or above and have health problems associated with this, or

 BMI of less than 35, and treatment with insulin would make it much more difficult to maintain lifestyle or other significant health problems would be helped by weight loss

 Prolonged-release exenatide can be given with one other drug (metformin or a sulphonylurea) only if:

 patient is not able to take either metformin or a sulphonylurea, and

 patient is not able to take thiazolidinediones and dipeptidyl peptidase-4 (DPP-4) inhibitors

 
Link  NICE TA248: MR exenatide
   
Liraglutide (Victoza)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

TA203 recommendations as above for exenatide

 
Link  NICE TA203: Diabetes (type 2) - liraglutide
   
Lixisenatide (Lyxumia▼)
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Formulary
Amber

Initiated by diabetes specialist only, in line with NICE guidance.

Continue only if a beneficial metabolic response (at least 1 percentage point HbA1c reduction and a weight loss of 3% within 6 months of starting treatment occurs and is maintained

 
   
06.01.02.03  Expand sub section  Meglitinides to top
06.01.02.03  Expand sub section  SGL2 inhibitors
Canagliflozin (Invokana▼)
(SGLT2 inhibitor)
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Formulary
Green 2

As per NICE guidance TA315

 
Link  NICE TA315: Canagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
   
Dapagliflozin (Forxiga▼)
(SGLT-2 inhibitor)
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Formulary
Green 2

**Care with Dosing**

10mg OD licensed for T2DM

5mg OD licensed for T1DM

 
Link  NICE TA288: 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
Link  NICE TA597: Dapagliflozin with insulin for treating Type 1 Diabetes
   
Empagliflozin (Jardiance▼)
(SGLT-2 inhibitor)
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Formulary
Green 2

As per NICE TA336

 
Link  NICE TA336: Empagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
   
Ertugliflozin
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Formulary
Green

As an option in line with NICE guidance

https://www.nice.org.uk/guidance/ta572

https://www.nice.org.uk/guidance/ta583

 
   
06.01.02.03  Expand sub section  Thiazolidinediones
Pioglitazone (Actos)
(Thiazolidinedione)
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Formulary
Green 2

May be used with insulin. Prescribe generically

Discontinue if clinically significant fluid retention occurs; contra-indicated in heart failure

 
   
 ....
 Non Formulary Items
Acarbose  (Glucobay)

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Non Formulary
 
Albiglutide  (Eperzan)

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Non Formulary
 
Alogliptin / metformin  (Vipdomet)

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Non Formulary
 
Alogliptin / pioglitazone  (Incresync)

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Non Formulary
 
Canagliflozin / metformin IR  (Vokanamet)

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Non Formulary
 
Dapagliflozin / metformin  (Xigduo)

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Non Formulary
 
Empagliflozin + linagliptin  (Glyxambi)

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Non Formulary
 
Empagliflozin and Metformin  (Synjardy)

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Non Formulary
 
Linagliptin/ metformin  (Jentadueto)

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Non Formulary
 
Lixisenatide+ insulin glargine  (Suliqua▼)

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Non Formulary
 
Nateglinide  (Starlix)

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Non Formulary
 
Pioglitazone and Metfomin  (Competact)

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Non Formulary
 
Repaglinide  (Prandin)

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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 dapagliflozin  (Qtern)

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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

Green

Suitable for use in primary care  

Amber

Specialist initiation. Shared care in place  

Red

Red do not use..  

Advice

Some formulations restricted  

Black

NICE "Do not do"  

Green 1

1st line option  

Green 2

2nd line option  

Green 3

3rd line option only  

Not Recomended / Black

Low Value Medicine not recommended for use - see NHSE guidelines  

OTC

This preparation should be bought over the counter for self-care  

Red Amber

Check product description for traffic light status  

Red Black

Low Value Medicine  

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