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 Formulary Chapter 6: Endocrine system - Full Chapter
Chapter Links...
Link   NTAG Endocrine System Recommendations
 Details...
06.01.02.03  Expand sub section  Other antidiabetic drugs
Acarbose
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Green 		 
 
Alogliptin
(DPP4 inhibitor)
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Green 		 
 
Dulaglutide (Trulicity®)
(GLP1 agonist)
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Green
  • 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

 

 
 
Exenatide
(GLP1 agonist)
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Green
  • 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)

 

 
Link  PCDS consensus statement: A strategy for managing the supply shortage of the GLP-1 RAs Ozempic and Trulicity
Link  EXENATIDE (Byetta®) - Information for Primary Care
 
Linagliptin
(DPP4 inhibitor)
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Green 		 
 
Liraglutide
(GLP1 agonist)
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  • Victoza® Green
    • Approved for the treatment of type 2 diabetes mellitus in accordance with NICE guidance   
  •  Saxenda®Red
    • 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 


 
Link  NICE NG28: Type 2 diabetes in adults: management
Link  NICE TA664: Liraglutide for managing overweight and obesity
 
Lixisenatide
(GLP1 agonist)
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Green 		 
 
Pioglitazone
(Thiazolidinedione)
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Green 		 
 
Repaglinide
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Green 		 
 
Saxagliptin (Onglyza®)
(DPP4 inhibitor)
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Green 		 
 
Semaglutide
(GLP1 agonist)
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Green
  • 0.25mg/0.19mL, 0.5mg0.37mL 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.

 

 
Link  NTAG Treatment Appraisal: Oral semaglutide for the treatment of type 2 diabetes mellitus.
 
Sitagliptin
(DPP4 inhibitor)
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Green 		 
 
Canagliflozin
(SGLT2 inhibitor)
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Green
  • Only approved for use in accordance with NICE guidance. 
 
Link  NICE TA315: Canagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
 
Dapagliflozin (Forxiga®)
(SGLT2 inhibitor)
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  • 5mg and 10mg tablets
    • Approved for treating type 2 diabetes in adults Green  
    • Approved for treating chronic heart failure with reduced ejection fraction Green plus
    • Approved for the treatment of chronic kidney disease in adults in line with NICE and NTAG Green

 

 
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 TA679: Dapagliflozin for treating chronic heart failure with reduced ejection fraction
Link  NICE TA775: Dapagliflozin for treating chronic kidney disease
 
Empagliflozin
(SGLT-2 inhibitor)
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  • Approved in combination therapy for treating type 2 diabetes in line with NICE Green
  • Approved for the treatment of type 2 diabetes in line with NICE Green
  • Approved for the treatment of chronic heart failure with reduced ejection fraction in adults in line with NICE Green plus

 

 
Link  NICE TA336: Empagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
Link  NICE TA773: Empagliflozin for treating chronic heart failure with reduced ejection fraction
 
Ertugliflozin
(SGLT-2 inhibitor)
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Green

 

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

 

 
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
 
Sotagliflozin
(SGLT-2 inhibitor)
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Green
  • 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

 

 
Link  NICE TA622: Sotagliflozin with insulin for treating type 1 diabetes
 
06.01.02.03  Expand sub section  Alpha glucosidase inhibitors
06.01.02.03  Expand sub section  DPP4 inhibitors (gliptins)
06.01.02.03  Expand sub section  GLP1 agonists
 link Link    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  Expand sub section  Meglitinides to top
06.01.02.03  Expand sub section  SGL2 inhibitors
 link Link    MHRA Drug Safety Updates: SGLT2 inhibitors
 link Link    NENC Guideline For Use Of Sodium Glucose Co-transporter 2 Inhibitors (SGLT2i) in Adults
06.01.02.03  Expand sub section  Thiazolidinediones
 ....
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
NHSE
 NHS England
Homecare
 Homecare
CCG
 CCG

Traffic Light Status Information

Status Description

Red

 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.  

Amber

 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.  

Green plus

 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.  

Green

 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.  

Black

 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.   

Brown

 UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

 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.  

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