| Formulary Chapter 6: Endocrine system - Full Chapter
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| Chapter Links... |
 NTAG Endocrine System Recommendations |
| Details... |
| 06.01.02.03 |
Other antidiabetic drugs |
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Repaglinide
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Formulary
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Alpha glucosidase inhibitors |
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Acarbose
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Formulary
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DPP4 inhibitors (gliptins) |
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Sitagliptin
(DPP4 inhibitor)
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First Choice
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Alogliptin
(DPP4 inhibitor)
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Formulary
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Linagliptin
(DPP4 inhibitor)
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Formulary
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Saxagliptin (Onglyza®)
(DPP4 inhibitor)
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Formulary
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GLP1 agonists |
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Dulaglutide (Trulicity®)
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Formulary
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- 0.75mg, 1.5mg, 3mg and 4.5mg prefilled syringes
- Approved for use in patients who require once-weekly GLP-1 receptor agonist therapy.
- This has replaced once-weekly exenatide. Existing patients can continue to receive exenatide until reviewed by a specialist
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NICE NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management
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Exenatide
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Formulary
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- 5 microgram and 10 microgram per dose are prefilled injection pens containing a 250microgram/ml solution for subcutaneous injection.
- Only approved for use in accordance with NICE guidance Treatment must be initiated by a consultant diabetologist and use is limited to overweight patients with type 2 diabetes in line with NICE guidelines.
- 2.5mg/0.85ml prolonged-release suspension for injection
- temporarily approved due to supply issues with semaglutide and dulaglutide
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Semaglutide
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Formulary
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- 0.25mg/0.19mL, 0.5mg/0.37mL and 1mg/0.7mL solution for injection pre-filled pen (Ozempic®)
- Approved for the treatment of type 2 diabetes in patients who require an intensification in treatment
- 3mg, 7mg & 14mg tablets (Rybelsus®) - BLACK TRIANGLE
- Approved as an option for patients with type 2 diabetes mellitus who require intensification of treatment, if use of a glucagon-like peptide 1 receptor agonist (GLP1RA) is clinically appropriate, in line with licensing and relevant guidance, and if an oral option is preferred.
- 0.25mg/0.37ml, 0.5mg/0.37ml, 1mg/0.75ml, 1.7mg/0.75ml & 2.4mg/0.75ml solution for injection pre-filled pens (Wegovy®)
- Approved for managing overweight and obesity in line with NICE guidance within a specialist weight management service (including but not limited to tiers 3 and 4)
- Also available via NHSE pilot sites involving primary care.
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NICE TA875: Semaglutide for managing overweight and obesity
 NTAG Treatment Appraisal: Oral semaglutide for the treatment of type 2 diabetes mellitus.
Tier 3 Weight Management Commissioning Statement
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Tirzepatide (Mounjaro®)
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Formulary
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- 2.5mg/0.6ml, 5mg/0.6ml, 7.5mg/0.6ml, 10mg/0.6ml, 12.5mg/0.6ml & 15mg/0.6ml solution for injection (pre-filled pens)
- Approved for treating type 2 diabetes in line with NICE
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NICE TA924: Tirzepatide for treating type 2 diabetes
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Liraglutide
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Formulary
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- Biosimilars available. These biosimilars should be prescribed by brand name as licensed indications differ.
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- Approved for the treatment of type 2 diabetes mellitus in accordance with NICE guidance
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- Approved as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults in line with NICE and providing:
- it is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service; and
- the company provides it according to the commercial arrangement
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NICE NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management
NICE NG28: Type 2 diabetes in adults: management
NICE TA664: Liraglutide for managing overweight and obesity
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Meglitinides |
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SGL2 inhibitors |
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Canagliflozin
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Formulary
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- Only approved for use in accordance with NICE guidance.
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NICE TA315: Canagliflozin for type 2 diabetes
NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
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Dapagliflozin (Forxiga®)
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Formulary
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- 5mg and 10mg tablets
- Approved for treating type 2 diabetes in adults
- Approved for the treatment of chronic kidney disease in adults in line with NICE and NTAG
- For details on use in Cardiovascular disease, please see entry in 02.15
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NICE TA288: Dapagliflozin in combination therapy for treating type 2 diabetes
NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
NICE TA418: Dapagliflozin in triple therapy for treating type 2 diabetes
NICE TA775: Dapagliflozin for treating chronic kidney disease
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Empagliflozin
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Formulary
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- Approved in combination therapy for treating type 2 diabetes in line with NICE
- Approved for the treatment of type 2 diabetes in line with NICE
- Approved for treating chronic kidney disease in line with NICE
- For details on use in Cardiovascular disease, please see entry in 02.15
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NICE NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management
NICE TA336: Empagliflozin for type 2 diabetes
NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
NICE TA942: Empagliflozin for treating chronic kidney disease
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Ertugliflozin
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Formulary
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- Approved as monotherapy or with metformin for the treatment of type 2 diabetes in line with NICE
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NICE TA572: Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes
NICE TA583: Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes
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Sotagliflozin
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Formulary
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- 200mg tablet
- Approved with insulin for treating type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy in line with NICE
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NICE TA622: Sotagliflozin with insulin for treating type 1 diabetes
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Thiazolidinediones |
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Pioglitazone
(Thiazolidinedione)
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Formulary
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. These medicines are considered suitable for primary care prescribing following specialist initiation of therapy and stabilisation, with ongoing communication between the primary care prescriber and specialist as set out in the associated shared care guideline (SCG). Shared care should be initiated by the specialist, which includes consultant, suitably trained specialist non-medical prescriber or GPwER within a secondary, tertiary, or primary care clinic.
The specialist should send the primary care prescriber a copy of the NENC Clinical Effectiveness and Governance (CEG) Subcommittee approved SCG to sign. The primary care prescriber should sign the SCG or indicate reasons why they are unable to accept the agreement and return a copy back to the specialist, as soon as possible.
SCGs are available or are being developed for most of the drugs listed as AMBER. |
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Drugs normally recommended or initiated by a hospital specialist who is a prescriber, a GP with an extended role [GPwER], or a specialist within primary care which can be safely maintained in primary care and monitored in primary care. In some cases, a further restriction for use may be defined. The primary care prescriber must be familiar with the drug to take on prescribing responsibility or must obtain the required information from the specialist. Therefore, provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by primary care prescriber or provide information re stopping criteria.
These are considered suitable for primary care prescribing following specialist assessment and recommendation of therapy, with ongoing communication between the primary care prescriber and specialist, if necessary.
In some case these drugs require specialist initiation and short to medium term monitoring of efficacy or toxicity until the patient’s dose is stable. Following specialist review the patient may be transferred to primary care for ongoing prescribing. Ongoing prescribing by primary care can include, if required, additional dose titrations and assessment of efficacy, with ongoing communication between the primary care prescriber and specialist, if necessary.
If the drug requires urgent initiation, it is expected that the specialist undertakes the initial prescribing responsibility for an appropriate period of time, usually a minimum of 28 days. A GREEN+ drug can only be recommended to primary care for initiation if does not need to be initiated within 28 days. |
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Medicines suitable for initiation, ongoing prescribing and discontinuation in all care settings, subject to appropriate communication between those responsible. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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Drugs that have been considered by the NENC Clinical Effectiveness and Governance (CEG) Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria ICS. These may also include all medicines with a “not NHS” or “DLCV” classification in the BNF, those agents as included within the NICE “Do not do” list, and those agents included with the NHS England: Items which should not routinely be prescribed in primary care. |
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