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Bedfordshire and Luton Joint Formulary
Bedford Hospital NHS Trust
Bedfordshire CCG
Luton & Dunstable University Hospital NHS Foundation Trust
Luton CCG
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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing

 Details...
06.01.02.03  Expand sub section  Other antidiabetic drugs
Alogliptin
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First Choice
Green
1st choice DPP4-inhibitor

12.5mg, 25mg Film Coated Tablets

 
Acarbose
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Formulary
Green
50mg & 100mg Tablets  
   
Canagliflozin
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Restricted Drug Restricted
Amber
100mg Tablets
Approved in accordance with NICE TA315 or TA390 for the treatment of type 2 diabetes in adults.

 
Link  MHRA Drug Safety Update (April 2016) - SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
Link  MHRA Drug Safety Update (June 2016) - Canagliflozin (Invokana▼, Vokanamet▼): signal of increased risk of lower extremity amputations observed in trial in high cardiovascular risk patients
Link  MHRA Drug Safety Update (March 2017): SGLT2 inhibitors- updated advice on the risk of lower-limb amputation
Link  MHRA DSU Feb 2019:SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
Link  NICE TA315: Canagliflozin in combination therapy for treating type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
   
Dapagliflozin
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Restricted Drug Restricted
Amber

10mg Film Coated Tablets

Approved in accordance with the following NICE TA(s):-

 
Link  MHRA Drug Safety Update (April 2016) - SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
Link  MHRA Drug Safety Update (March 2017): SGLT2 inhibitors- updated advice on the risk of lower-limb amputation
Link  MHRA DSU Feb 2019: SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
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  TA597 Dapagliflozin with insulin for treating type 1 diabetes
   
Empagliflozin
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Restricted Drug Restricted
Amber
10mg & 25mg Film Coated Tablets

Approved in accordance with TA336 or TA390 for the treatment of type 2 diabetes in adults.  
Link  MHRA Drug Safety Update (April 2016) - SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
Link  MHRA Drug Safety Update (March 2017): SGLT2 inhibitors- updated advice on the risk of lower-limb amputation
Link  MHRA DSU Feb 2019:SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
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
   
Ertugliflozin 15mg  (Steglatro®)
(Tablets)
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Restricted Drug Restricted
Amber

Use in accordance with NICE TA (s) below.

 

 
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
   
Linagliptin
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Formulary
Green
5mg Film Coated Tablets 
   
Pioglitazone
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Restricted Drug Restricted
Green
15mg, 30mg & 45mg Tablets

Restricted - to be used in accordance with NICE Clinical Guideline NG28 Management of Type 2 Diabetes 
Link  MHRA Drug Safety Update (August 2011) - Pioglitazone: risk of bladder cancer
Link  MHRA Drug Safety Update (January 2011) - Insulin combined with pioglitazone: risk of cardiac failure
Link  Type 2 diabetes in adults: management (NG28) (Dec 15)
   
Repaglinide
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Formulary
Green
0.5mg, 1mg 2mg tablets

 
   
Sitagliptin 25mg, 50mg, 100mg (Januvia®)
(Tablets)
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Formulary
Green
 
   
06.01.02.03  Expand sub section  DPP-4 inhibitors
06.01.02.03  Expand sub section  GLP-1 mimetics
Liraglutide
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Restricted Drug Restricted
Amber SCG

First choice

To be initiated by a Diabetes specialist in line with NICE Guidance NG28.

6mg/1mL Injection

 
Semaglutide 0.25mg, 0.5mg, 1mg
(pre-filled pen)
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Restricted Drug Restricted
Amber SCG

Second choice

Only to be initiated by Specialist Diabetes team in line with JPC guidance

 
Link  MHRA DSU June 2019: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
   
Dulaglutide 0.75mg, 1.5mg (Trulicity®)
(Pre-filled pen or syringe)
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Restricted Drug Restricted
Amber SCG

Third Choice

For specialist initiation in-line with JPC guidance and shared care guideline (see link below).

 
Link  JPC Shared Care Guideline for Glucagon-like peptide 1 (GLP 1) agonists, February 2017
Link  MHRA DSU June 2019: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
   
Exenatide prolonged release (Bydureon▼®)
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Restricted Drug Restricted
Amber SCG

Restricted - to prescribing by Diabetologists only, in accordance with NICE TA248.

2mg MR pre-filled pen (has now replaced syringe and vial)

 
Link  JPC Shared Care Guideline for Glucagon-like peptide 1 (GLP 1) agonists, February 2017
Link  MHRA DSU June 2019: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
Link  NICE TA248: MR exenatide
   
06.01.02.03  Expand sub section  SGLT2 inhibitors
06.01.02.03  Expand sub section  Other to top
 ....
 Non Formulary Items
Albiglutide  (Eperzan®)

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Non Formulary N.B. To be discontinued by July 2018
 
Alogliptin / metformin  (Vipdomet®)

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Non Formulary
 
Alogliptin / pioglitazone  (Incresync®)

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Non Formulary
 
Canagliflozin / metformin IR  (Vokanamet®)

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Non Formulary
Link  MHRA Drug Safety Update (June 2016) - Canagliflozin (Invokana▼, Vokanamet▼): signal of increased risk of lower extremity amputations observed in trial in high cardiovascular risk patients
 
Dapagliflozin / metformin  (Xigduo®)

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Non Formulary
 
Empagliflozin and Metformin  (Synjardy®)

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Non Formulary
 
Empagliflozin and Metformin  (Synjardy®)

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Non Formulary
 
Exenatide  (Byetta®)

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Non Formulary
Amber SCG

5microgram , 10microgram Pre-Filled Pen

no new initiations, existing patients may remain on this preparation 

Link  JPC Shared Care Guideline for Glucagon-like peptide 1 (GLP 1) agonists, February 2017
Link  MHRA Drug Safety Update (March 2009) - Exenatide (Byetta ▼): risk of severe pancreatitis and renal failure
Link  MHRA DSU June 2019: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
 
Linagliptin/ metformin  (Jentadueto®)

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Non Formulary
 
Lixisenatide

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Non Formulary
Amber SCG

No prescribing for new patients following JPC June 2019
 
50microgram/1mL Pre-filled Pen
100microgram/1mL Pre-filled Pen

Link  JPC Shared Care Guideline for Glucagon-like peptide 1 (GLP 1) agonists, February 2017
Link  MHRA DSU June 2019: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
 
Nateglinide  (Starlix®)

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Non Formulary
 
Pioglitazone and Metfomin  (Competact®)

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Non Formulary
 
Rosiglitazone  (Avandia®)

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Non Formulary
 
Rosiglitazone and Metformin  (Avandamet®)

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Non Formulary
 
Saxagliptin  (Onglyza®)

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Non Formulary
 
Saxagliptin and metformin  (Komboglyze®)

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Non Formulary
 
Sitagliptin and Metformin  (Janumet®)

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Non Formulary
 
Vildagliptin

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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
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
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

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations   

Amber SCG

Shared Care - these medicines require 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.   

Black

A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.   

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