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Airedale, Wharfedale and Craven CCG
 
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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand. 
 Details...
06.01.02.03  Expand sub section  Other antidiabetic drugs
Alogliptin (Vipidia®)
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First Choice
Green

Supported for use in adult patients with Type 2 diabetes, to improve glycaemic control in combination with other glucose lowering medicinal products including insulin
 

 
Sitagliptin (Januvia®)
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First Choice
Green
Supported as first-line monotherapy choice for patients inadequately controlled by diet and exercise alone and for whom metformin is inappropriate due to contraindications or intolerance.

 
Linagliptin (Trajenta®)
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Second Choice
Amber

Use supported for the treatment of type 2 diabetes, as an alternative to sitagliptin, in patients with moderate to severe renal impairment. Specialist recommendation use only.

 
   
Saxagliptin (Onglyza®)
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Formulary
Amber

Specialist recommendation use only.

 
Link  DSU: Dipeptidylpeptidase-4 inhibitors: risk of acute pancreatitis (September 2012)
Link  Serious hypersensitivity reactions & acute pancreatitis - Dear HCP Letter (March 2012)
Link  FDA warning: Heart failure risk (February 2014)
   
Exenatide (Byetta®, Bydureon®)
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Restricted Drug Restricted
Amber

Exenatide pre-filled pens 250micrograms/mL  - Byetta®

  • Specialist Initiation Only

Exenatide MR Injection 2mg - Bydureon®

  • For patients who have already been established on the TWICE DAILY formulation and who would benefit from a change to ONCE WEEKLY preparation.
  • Supported for use in-line with NICE NG28 (May 2017)
 
Link  DSU: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued (June 2019)
Link  NG28:Type 2 diabetes in adults: management (May 2017)
   
Semaglutide (Ozempic®)
(Pre-filled Pen)
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Formulary
Amber
  • Semaglutide Pre-filled Pen

First line long acting GLP-1 receptor agonist, in-line with NG28.

 
   
Dulaglutide  (Trulicity®)
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Restricted Drug Restricted
Amber
  • Supported for the treatment of type 2 diabetes as an alternative to exenatide LA for patients already established on a daily GLP-1 agonist who would benefit from once-weekly dosing and who are unable to receive treatment with exenatide LA
  • Specialist initiation only
     
  • Link  DSU: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued (June 2019)
       
    Liraglutide (Victoza®)
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    Restricted Drug Restricted
    Amber
    • Liraglutide should be started only if patients have persistent nausea when on exenatide.
    • Supported for use in-line with NG28 (May 2017)

     BlackLiraglutide (Saxenda) for the treatment of obesity. Not routinely  commissioned.

     
    Link  DSU: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued (June 2019)
    Link  NICE NG28: Type 2 diabetes in adults: management (May 2017)
       
    Lixisenatide subcutaneous injection (Lyxumia®)
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    Restricted Drug Restricted
    Amber
    For the treatment of Type 2 diabetes in-line with NICE recommendations for the use of a GLP-1 agonist and as a cost effective alternative to exenatide or liraglutide. 
       
    Acarbose
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    Formulary
    Black

    Acarbose 50mg tablets

    For existing patients only.

     
       
    Canagliflozin  (Invokana®)
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    Formulary
    Green
    Approved for use for type two diabetes as an alternative to dapagliflozin in patients with poor renal function and in line with NICE TA315. 
    Link  Drug Safety Update: Canagliflozin (Invokana, Vokanamet): signal of increased risk of lower extremity amputations observed in trial in high cardiovascular risk patients (June 2016)
    Link  Drug Safety Update: SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis (June 2015)
    Link  Drug Safety Update: SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) (February 2019)
    Link  Drug Safety Update; SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness (March 2020)
    Link  EMA confirms recommendations to minimise ketoacidosis risk with SGLT2 inhibitors for diabetes (February 2016)
    Link  EMA: SGLT2 inhibitors: information on potential risk of toe amputation to be included in prescribing information (February 2017)
    Link  MHRA Drug Safety Update: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes) (March 2017)
    Link  NICE TA315: Canagliflozin in combination therapy for treating type 2 diabetes (June 2014)
    Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes. (May 2016)
       
    Dapagliflozin  (Forxiga®)
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    Restricted Drug Restricted
    Amber
    For use by the diabetic team as dual therapy for the treatment of type 2 diabetes in-line with NICE TA288,TA390 and TA418. 
    Link  Drug Safety Update: SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis (June 2015)
    Link  Drug Safety Update: SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness (March 2020)
    Link  Drug Safety Update: SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) (February 2019)
    Link  EMA confirms recommendations to minimise ketoacidosis risk with SGLT2 inhibitors for diabetes (February 2016)
    Link  EMA: SGLT2 inhibitors: information on potential risk of toe amputation to be included in prescribing information (February 2017)
    Link  MHRA Drug Safety Update: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes) (March 2017)
    Link  NICE TA288: Type 2 diabetes - Dapagliflozin combination therapy (June 2013)
    Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes (May 2016)
    Link  NICE TA418: Dapagliflozin in triple therapy for treating type 2 diabetes (Nov 2016)
    Link  NICE TA597: Dapagliflozin with insulin for treating type 1 diabetes (August 2019
       
    Empagliflozin (Jardiance®)
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    Formulary
    Amber
    For the treatment of type two diabetes in-line with NICE TA336. Use restricted to Specialist initiation only. 
    Link  Drug safety update: SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis (June 2015)
    Link  Drug Safety Update: SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness (March 2020)
    Link  Drug Safety Update: SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) (February 2019)
    Link  Drug safety update: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes) (March 2017)
    Link  EMA: EMA confirms recommendations to minimise ketoacidosis risk with SGLT2 inhibitors for diabetes (February 2016)
    Link  EMA: SGLT2 inhibitors: information on potential risk of toe amputation to be included in prescribing information (February 2017)
    Link  NICE TA336: Empagliflozin in combination therapy for treating type 2 diabetes (March 2015)
    Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes (May 2016)
       
    Ertugliflozin (Steglatro®)
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    Formulary
    Green
    • Ertugliflozin Tablets 

    For as monotherapy or in combination with metformin treatment of Type 2 diabetes in-line with NICE TA572.

     
    Link  Drug Safety Update; SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness (March 2020)
    Link  NICE TA572: Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes (March 2019)
    Link  NICE TA583: Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes (June 2019)
       
    Pioglitazone
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    Formulary
    Green

    Diabetes

    • Glitazones should only be tried if HbA1C not reducing on metformin and sulphonylurea, and should be stopped if HbA1C is not reduced by 6mmol within six months.

      Non-Alcoholic Fatty Liver Disease (NAFLD)
    • Pioglitazone is recommended as an option for treating NAFLD. See NICE guidance link below. Note: this is an off-label use of pioglitazone.
     
    Link  DSU:Risk of bladder cancer (August 2011)
    Link  Risk of cardiac failure when combined with insulin (MHRA safety update Jan 2011)
    Link  NICE NG49: Non-alcoholic fatty liver disease (NAFLD): assessment and management (July 2016)
       
     ....
     Non Formulary Items
    Insulin degludec/liraglutide (100units + 3.6mg/mL)  (Xultophy®)

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    Non Formulary
    Black
    Not routinely commissioned. Fixed-dose ratio of the combination product does not allow for the insulin and GLP-1 analogue doses to be titrated separately, and additional clinical benefit over using separate products concomitantly has not been demonstrated.
     
      
    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
    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

    Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

    Amber

    Amber - these drugs require specialist initiation or recommendation  

    Amber SCG

    Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

    Red

    Red - Drugs for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Red ULM

    Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

    Grey

    Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

    Black

    Black - Drugs not routinely commissioned so should not usually be prescribed  

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