North East and North Cumbria Formulary


	North East and North Cumbria ICS Formulary

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Formulary Chapter 6: Endocrine system - Full Chapter

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NTAG Endocrine System Recommendations

Details...

06.01.02.03

Other antidiabetic drugs

Repaglinide

Formulary

06.01.02.03

Alpha glucosidase inhibitors

Acarbose

Formulary

06.01.02.03

DPP4 inhibitors (gliptins)

Sitagliptin
(DPP4 inhibitor)

First Choice

Alogliptin
(DPP4 inhibitor)

Formulary

Linagliptin
(DPP4 inhibitor)

Formulary

Saxagliptin (Onglyza^®)
(DPP4 inhibitor)

Formulary

06.01.02.03

GLP1 agonists

Dulaglutide (Trulicity^®)

Formulary

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

National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update

NICE NG18: Diabetes (type 1 and type 2) in children and young people: diagnosis and management

Exenatide

Formulary

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 (please refer to linked advice below)

National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update

Lixisenatide

Formulary

National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update

Semaglutide

Formulary

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
- Note: As of 29^th April 2024 there is an ICB weight management strategy in development which is seeking to review the arrangements and capacity of current service provision across the ICS

National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update

NICE TA875: Semaglutide for managing overweight and obesity

NTAG Treatment Appraisal: Oral semaglutide for the treatment of type 2 diabetes mellitus.

Tirzepatide (Mounjaro^®)

Formulary

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

NICE TA924: Tirzepatide for treating type 2 diabetes

Liraglutide

Formulary

Victoza^®
- Approved for the treatment of type 2 diabetes mellitus in accordance with NICE guidance

Saxenda^®
- 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

National Patient Safety Alert - Shortage of GLP-1 receptor agonists (GLP-1 RA) update

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

MHRA Drug Safety Update (October 2024) : GLP-1 receptor agonists: reminder of the potential side effects and to be aware of the potential for misuse

PCDS consensus statement: A strategy for managing the supply shortage of the GLP-1 RAs Ozempic and Trulicity

MHRA Drug Safety Update (Jun 2019): GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

06.01.02.03

Meglitinides

06.01.02.03

SGL2 inhibitors

Canagliflozin

Formulary

Only approved for use in accordance with NICE guidance.

NICE TA315: Canagliflozin for type 2 diabetes

NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes

Dapagliflozin (Forxiga^®)

Formulary

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

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

Empagliflozin

Formulary

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

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

Ertugliflozin

Formulary

Approved as monotherapy or with metformin for the treatment of type 2 diabetes in line with NICE

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

Sotagliflozin

Formulary

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

NICE TA622: Sotagliflozin with insulin for treating type 1 diabetes

MHRA Drug Safety Updates: SGLT2 inhibitors

NENC Guideline For Use Of Sodium Glucose Co-transporter 2 Inhibitors (SGLT2i) in Adults

06.01.02.03

Thiazolidinediones

Pioglitazone
(Thiazolidinedione)

Formulary

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Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to children's BNF
	Link to SPCs

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	NHS England
	Homecare
	CCG

Traffic Light Status Information

Status	Description
	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.
	Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.
	Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.
	Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.
	NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.
	UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.
	NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.