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 Formulary Chapter 6: Endocrine system - Full Chapter
06.01.02.03  Expand sub section  Other antidiabetic drugs
Acarbose (Glucobay®)
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Formulary
Green

Acarbose Tablets 50mg
Acarbose Tablets 100mg

 
   
Canagliflozin (Invokana®)
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Formulary
Green

Canagliflozin Tablets 100mg
Canagliflozin Tablets 300mg

Restriction: In line with NICE Guidance only

For mono, dual & triple therapy -  should not be initiated in patients with an eGFR < 60 mL/min/1.73 m2 or CrCl < 60 mL/min. In patients tolerating canagliflozin whose eGFR falls persistently below 60 mL/min/1.73 m2 or CrCl 60 mL/min, the dose of canagliflozin should be adjusted to or maintained at 100 mg once daily. Canagliflozin should be discontinued when eGFR is persistently below 45 mL/min/1.73 m2 or CrCl persistently below 45 mL/min 

MHRA/CHM advice (updated April 2016): Risk of diabetic ketoacidosis with sodium-glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin, dapagliflozin or empagliflozin)

MHRA/CHM advice (updated March 2017): Increased risk of lower-limb amputation (mainly toes)

MHRA advice- SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) (Feb 2019)

 
Link  NICE TA315: Canagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
Link  SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
   
Dapagliflozin (Forxiga®)
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Formulary
Green

Dapagliflozin Tablets 5mg
Dapagliflozin Tablets 10mg

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 (canagliflozin, dapagliflozin or empagliflozin)

MHRA advice- SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) (Feb 2019)

 
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  SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
   
Dapagliflozin (Forxiga®)
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Formulary
Amber

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

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 (canagliflozin, dapagliflozin or empagliflozin)

MHRA advice- SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) (Feb 2019)

 

 
Link  NICE TA597: Dapagliflozin with insulin for treating type 1 diabetes
Link  SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fascitis of the genitalia or perineum)
   
Empagliflozin (Jardiance▼®)Black Triangle
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Formulary
Green

Empagliflozin Tablets 10mg
Empagliflozin Tablets 25mg

Restriction: In line with NICE Guidance only

For mono, dual & triple therapy  - should not be initiated in patients with an eGFR 2 or CrCl 2 or CrCl below 60 ml/min, the dose of empagliflozin should be adjusted to or maintained at 10 mg once daily. Empagliflozin should be discontinued when eGFR is persistently below 45 ml/min/1.73 m2 or CrCl persistently below 45 ml/min

MHRA/CHM advice (updated April 2016): Risk of diabetic ketoacidosis with sodium-glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin, dapagliflozin or empagliflozin)

MHRA advice- SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) (Feb 2019)

 
Link  NICE TA336: Empagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
Link  SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
   
Ertugliflozin (Steglatro®)Black Triangle
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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)
   
Pioglitazone (Actos®)
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Formulary
Green

Pioglitazone Tablets 15mg
Pioglitazone Tablets 30mg
Pioglitazone Tablets 45mg

1st line thiazolidinedione

MHRA/CHM advice: Pioglitazone cardiovascular safety (December 2007 and January 2011)

EMA: Pioglitazone: risk of bladder cancer (July 2011)

 
   
Repaglinide (Prandin®)
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Formulary
Green

Repaglinide Tablets 0.5mg
Repaglinide Tablets 1mg
Repaglinide Tablets 2mg

Alternative to a sulphonylurea when it is not tolerated or is inappropriate

 
   
06.01.02.03  Expand sub section  DPP4 inhibitors (gliptins)
Alogliptin (Vipidia®)
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Formulary
Green

Alogliptin Tablets 6.25mg
Alogliptin Tablets 12.5mg
Alogliptin Tablets 25mg

Preferred DPP-4 inhibitor

Reduce dose to 12.5 mg once daily if eGFR 30–50 mL/minute/1.73 m2.
Reduce dose to 6.25 mg once daily if eGFR less than 30 mL/minute/1.73 m2.

 
   
Linagliptin (Trajenta®)
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Formulary
Green

Linagliptin Tablets 5mg

 
   
Sitagliptin (Januvia®)
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Formulary
Green

Sitagliptin Tablets 25mg
Sitagliptin Tablets 50mg
Sitagliptin Tablets 100mg

 
   
06.01.02.03  Expand sub section  GLP1 agonists
Exenatide  (Bydureon®)
(Once weekly)
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Formulary
Amber

Bydureon 2 mg powder and solvent for prolonged-release suspension for injection pre-filled pen 

Restriction: Only for patients who cannot tolerate twice daily exenatide (Byetta® )

Restriction: Treatment should be initiated by secondary care endocrinologists and transferred to primary care after six months as long as the patient has had a beneficial metabolic process, i.e. at least a 1% HbA1c reduction AND at least a 3% reduction in weight.

For modified-release injection, avoid if eGFR less than 50 mL/minute/1.73 m2.

 

 
Link  NICE NG28: Type 2 diabetes in adults: management
   
Exenatide  (Byetta®)
(Twice daily)
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Formulary
Amber

Byetta 5micrograms/0.02mL solution for injection 1.2mL pre-filled pen
Byetta 10micrograms/0.04mL solution for injection 2.4mL pre-filled pen

Restriction: Treatment should be initiated by secondary care endocrinologists and transferred to primary care after six months as long as the patient has had a beneficial metabolic process, i.e. at least a 1% HbA1c reduction AND at least a 3% reduction in weight.

For standard-release injection, avoid if eGFR less than 30 mL/minute/1.73 m2.

 
   
Liraglutide (Victoza®)
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Formulary
Amber

Liraglutide 6 mg/ml 3ml prefilled pen

Restriction: Liraglutide should be used second line to exenatide in patients where exenatide is not tolerated or not effective (i.e. exenatide twice daily (Byetta® ) was not effective OR exenatide twice daily (Byetta® ) was not tolerated and exenatide once weekly (Bydureon® ) was not effective).

Patients should receive at least 3 months of exenatide before liraglutide is prescribed. Treatment should be initiated by secondary care endocrinologists and transferred to primary care after 6 months treatment with liraglutide as long as the patient has had a beneficial metabolic process, i.e. at least a 1% HbA1c reduction AND at least a 3% reduction in weight

 
Link  NICE NG28: Type 2 diabetes in adults: management
   
Semaglutide (Ozempic®)Black Triangle
(Once weekly)
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Formulary
Amber

Ozempic 0.25mg/0.19mL Solution for injection 1.5mL pre-filled pens
Ozempic 0.5mg/0.37mL Solution for injection 1.5mL pre-filled pens
Ozempic 1mg/0.74mL Solution for injection 3mL pre-filled pens

Restriction: Treatment should be initiated by secondary care endocrinologists and transferred to primary care after six months as long as the patient has had a beneficial metabolic process, i.e. at least a 1% HbA1c reduction AND at least a 3% reduction in weight.

 
Link  NICE NG28: Type 2 diabetes in adults: management
   
 ....
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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

Medicines that can only be prescribed within Secondary Care. Examples of medicines which fall into this category are: Certain new medicines and new indications for older medicines where there is at present no experience of use in Primary Care. Medicines or dressings not available or prescribable in Primary Care. Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available   

Amber

Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral. There is no need for approved shared care guidelines for medicines in this category. This replaces Amber 2 on the North Staffs Formulary.   

Amber E

Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD). This replaces Amber 1 on the North Staffs Formulary  

Green

Medicines which can be prescribed in either Primary or Secondary Care.  

Grey

These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary. Inadequate or weak evidence for efficacy No clearly defined local need Lack of long term safety data No perceived benefit over established formulary alternatives Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or not tolerated.  

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