netFormulary NHS
Herefordshire & Worcestershire
Medicines and Prescribing Committee
 Search
 Formulary Chapter 6: Endocrine system - Full Chapter
06.01.02.03  Expand sub section  Other antidiabetic drugs
06.01.02.03  Expand sub section  Alpha glucosidase inhibitors
Acarbose
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
06.01.02.03  Expand sub section  DPP4 inhibitors (gliptins)
Alogliptin
View adult BNF View SPC online View childrens BNF
First Choice
Green

There does not appear to be any significant clinical advantages over other DPP-4 inhibitors but overall it appears that this is the most cost effective option.

 
Alogliptin with metformin
View adult BNF View SPC online View childrens BNF
Formulary
Green

There does not appear to be any significant clinical advantages over other DPP-4 inhibitors but overall it appears that this is the most cost effective option.

 
 
Sitagliptin
View adult BNF View SPC online View childrens BNF
Formulary
Green

25mg and 50mg doses are available on the formulary to enable dosage adjustment according to renal function.

 
 
Sitagliptin with metformin
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Saxagliptin
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
 
Linagliptin
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Green

For use in patients with renal impairment.

 
 
06.01.02.03  Expand sub section  SGLT2 inhibitors
Ertugliflozin
View adult BNF View SPC online View childrens BNF
Formulary
Green

In line with NICE TA572

 
Link  NICE TA 572: Ertugliflozin as monotherapy or with metformin for treating Type 2 Diabetes
 
Canagliflozin
View adult BNF View SPC online View childrens BNF
Formulary
Green

In Line with NICE TA315 and NICE TA390

 
Link  MHRA Drug Safety Update (April 2017): SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes)
Link  NICE TA 315 Canagliflozin in combination therapy for treating type 2 diabetes
Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
 
Dapagliflozin
View adult BNF View SPC online View childrens BNF
Formulary

Green In line with NICE TA288 for patients with type 2 diabetes.(Please note TA288 has been partially updated - see TA418), TA390 and TA418.


Amber In line with NICE TA 597 for patients with type 1 diabetes: Initiation and prescribing of dapagliflozin with insulin in T1DM patients to be retained by secondary care for the first six months, with the request for GPs to take over maintenance prescribing if the specialist deems there to be the required improvement in HbA1c (i.e. at least 0.3%) and the patient has received any additional monitoring guidance and education about increased risk of DKA.


 Amber In line with NICE TA 679 for the treatment of chronic heart failure with reduced ejection fraction.


 

 
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
Link  NICE TA679 Dapagliflozin for treating chronic heart failure with reduced ejection fraction
 
Dapagliflozin with metformin
View adult BNF View SPC online View childrens BNF
Formulary
Green

In line with NICE TA288 'Dapagliflozin in Combination Therapy for Treating Type 2 Diabetes'.

 
Link  NICE TA288 Dapagliflozin in combination therapy for treating type 2 diabetes
 
Empagliflozin
View adult BNF View SPC online View childrens BNF
Formulary
Green

In line with NICE TA336 and TA390

 
Link  NICE TA336: Empagliflozin in combination therapy for treating type 2 diabetes
Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
 
06.01.02.03  Expand sub section  GLP1 agonists to top
Semaglutide S/C injection
View adult BNF View SPC online View childrens BNF
First Choice

Green  SEMAGLUTIDE SHOULD BE THE PRODUCT OF CHOICE WHEN A ONCE WEEKLY GLP-1 AGONIST IS TO BE USED.


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

 
Lixisenatide S/C injection
View adult BNF View SPC online View childrens BNF
First Choice

 Green LIXISENATIDE SHOULD BE THE PRODUCT OF CHOICE WHEN A DAILY   GLP-1 AGONIST IS TO BE USED.


 Amber When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.

 
Dulaglutide S/C injection
View adult BNF View SPC online View childrens BNF
Formulary

 


Green


Amber  When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.

 
 
Exenatide 2mg prolonged release (S/C injection)
View adult BNF View SPC online View childrens BNF
Formulary

 


Green


Amber  When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.


 

 
 
Liraglutide S/C injection
View adult BNF View SPC online View childrens BNF
Formulary

1.8mg dose not recommended.


Green


Amber  When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin.

 
 
Semaglutide oral tabletsBlack Triangle (Rybelsus®)
View adult BNF View SPC online View childrens BNF
Formulary

Rybelsus is a tablet for once-daily oral use but has special administration directions:



  • It must be taken on an empty stomach at any time of the day.

  • Patients are required to wait at least 30 minutes before eating/drinking or taking other oral medicinal products. Waiting less than 30 minutes decreases absorption.

  • It should be swallowed whole with a sip of water (up to half a glass of water equivalent to 120 ml).


Green  For patients where a GLP1 analogue is indicated but an oral preparation is more suitable.


Amber  When administration is with insulin: In line with NICE NG28, diabetes specialist initiation advice/recommendation should be sought when initiating GLP1 agonists in combination with insulin. 


All patients should be reviewed within 6 months of initiation to assess effectiveness.

 
 
06.01.02.03  Expand sub section  Meglitinides
Repaglinide
View adult BNF View SPC online View childrens BNF
Formulary
Green

Second line add-on therapy to metformin for patients with irregular eating habits where HbA1c <8.5% 

OR

As an alternative to adding a glitazone in patients failing targets on metformin/sulfonylurea treatments (or on metformin alone where standard sulfonylureas have been problematic, where HbA1c <8.5%)

OR

Occasionally as monotherapy in lean type 2 patients where standard sulfonylureas have resulted in preprandial hypoglycaemia.

 
 
06.01.02.03  Expand sub section  Other
06.01.02.03  Expand sub section  Thiazolidinediones
Pioglitazone
View adult BNF View SPC online View childrens BNF
Formulary
Green
 
Link  MHRA Drug Safety Update December 2014 - drug-safety-update/insulin-combined-with-pioglitazone-risk-of-cardiac-failure
 
 ....
 Non Formulary Items
Exenatide  (Byetta®)

View adult BNF View SPC online View childrens BNF
Non Formulary

*LIXISENATIDE was approved for addition to the formulary in place of the less affordable twice daily exenatide preparation (Byetta®▼)

Vildagliptin  (Galvus®)

View adult BNF View SPC online View childrens BNF
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
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

Secondary care only, not to be prescribed in primary care.   

Amber 2

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber with Shared Care

Specialist initiation with shared care guidance Medicines which should be initiated in secondary care by the specialist with follow-on prescription and monitoring according to a specific Shared Care (SC) Guideline. Prescribing may be continued in primary care in line with a shared care guideline   

Amber

Considered suitable for primary care prescribing following specialist initiation/recommendation.  

Green

Considered appropriate for prescribing in both secondary and primary care. Suitable for initiation in primary care.   

netFormulary