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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:
Please contact EKHUFT Medicines Information ext. 7236001 or 01233 616001 with any queries.NHS
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06.01.02.03  Expand sub section  Other antidiabetic drugs
Acarbose (Glucobay®)
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Restricted Drug Restricted
Green
Tablets
  • Consider acarbose for a person unable to use other oral glucose-lowering medications. (NICE CG87) 
  •    
    Alogliptin (Vipidia®)
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    Restricted Drug Restricted
    Green
    As of June 2014 the cheapest gliptin. 
    Link  East Kent Prescribing Group Alogliptin
    Link  NICE ESNM20 Type 2 diabetes: alogliptin
       
    Canagliflozin (Invokana®)
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    Restricted Drug Restricted
    Green
  • Use only as per East Kent Prescribing Group Guidelines and relevant NICE Technical Appraisals 3 months after their publication date.
    Warning
    • Risk normoglycaemic diabetic ketoacidosis. Interrupt treatment with the SGLT2 inhibitor in patients who are hospitalised for major surgery or acute serious illnesses; treatment may be restarted once the patient’s condition has stabilised
    • Risk osteoporosis
    • Increased risk of significant peripheral vascular disease complications


     
  • 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 (Forxiga®)
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    Restricted Drug Restricted
    Green
    Tablets
  • Use only as per East Kent Prescribing Group Guidelines and relevant NICE Technical Appraisals 3 months after their publication date.
    Warning
    • Risk normoglycaemic diabetic ketoacidosis. Interrupt treatment with the SGLT2 inhibitor in patients who are hospitalised for major surgery or acute serious illnesses; treatment may be restarted once the patient’s condition has stabilised
    • Risk osteoporosis
    • Unknown at this time if increased risk of significant peripheral vascular disease complications

    Warning STOP if eGFR < 60 mL/min/1.73 m2
     
  • Link  Dapaglaflozin with insulin for treating type 1 diabetes
    Link  NICE TA 597 Dapagliflozin with insulin for treating type 1 diabetes
    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
       
    Empagliflozin (Jardiance®)
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    Formulary
  • Use only as per East Kent Prescribing Group Guidelines and relevant NICE Technical Appraisals 3 months after their publication date.
    Warning
    • Risk normoglycaemic diabetic ketoacidosis. Interrupt treatment with the SGLT2 inhibitor in patients who are hospitalised for major surgery or acute serious illnesses; treatment may be restarted once the patient’s condition has stabilised
    • Unknown at this time if increased risk osteoporosis
    • Unknown at this time if increased risk of significant peripheral vascular disease complications

     
  • Link  NICE TA 336: Empagliflozin in combination therapy for treating type 2 diabetes
    Link  NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
       
    Exenatide (Bydureon®)
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    Restricted Drug Restricted
    Green
    Injection
  • Kent & Medway Shared Care
  • Diabetologist
  • Once weekly formulation
  • Effect of Bydureon® may persist for 10 weeks after discontinuation
    WarningThe recommendation of the Trust diabetiologists is with Modified/once weekly (2mg) – STOP if eGFR <50mL/min/1.73 m2
     
  • Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
       
    Exenatide (Byetta®)
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    Restricted Drug Restricted
    Green
    Injection
  • Diabetologist
  • Twice daily formulation
    The recommendation of the Trust diabetiologists is with standard release:
    WarningCaution if eGFR 30-50mL/min/1.73 m2
    WarningSTOP if eGFR < 30mL/min/1.73 m2
     
  • Link  MRHA warning on risk of acute pancreatitis and renal failure (2009)
    Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
       
    Linagliptin
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    Restricted Drug Restricted
    Green
    Tablets
  • as per East Kent Prescribing Group Guidelines
  • For renal impairment ONLY


     
  •    
    Liraglutide (Victoza®)
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    Restricted Drug Restricted
    Green
    Injection as 6mg/ml prefilled pen
  • Diabetologists
    WarningThe recommendation of the Trust diabetiologists is STOP if eGFR < 60mL/min/1.73 m2 
  • Link  NICE TA203: Diabetes (type 2) - liraglutide
    Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
       
    Lixisenatide (Lyxumia®)
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    Restricted Drug Restricted
    Green
    Injection
    • Diabetologist
    • First line GLP-1 mimetic. Use within NICE guidance as per other GLP-1 mimetics
    NICE ESNM NICE ESNM26 Type 2 diabetes: lixisenatide Sept 2013 
    Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
    Link  NICE CG 87 Type 2 diabetes- The management of type 2 diabetes
       
    Pioglitazone (Actos®)
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    Restricted Drug Restricted
    Green
    Tablets
  • as per East Kent Prescribing Group Guidelines
    WarningRisk of exacerbating heart failure in renal impairment





    STOPP v2 recommendation Thiazolidenediones (e.g. rosiglitazone, pioglitazone) inappropriate to use in patients aged 65 years and older with heart failure (risk of exacerbation of heart failure).
     
  • Link  Risk of bladder cancer: MHRA safety update
    Link  Risk of cardiac failure when combined with insulin (MHRA safety update Jan 2011)
       
    Repaglinide (Prandin®)
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    Restricted Drug Restricted
    Green
    Tablets
  • Consider offering a rapid-acting insulin secretagogue to a person with an erratic lifestyle.
    WarningThe recommendation of the Trust diabetiologists is use with caution in renal impairment 
  •    
    Sitagliptin (Januvia®)
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    Restricted Drug Restricted
    Green
    Tablets
  • as per East Kent Prescribing Group Guidelines
    WarningReduce dose to 50mg OD if eGFR 30-50 mL/min/1.73 m2
    WarningReduce dose to 25mg OD if eGFR < 30mL/min/1.73 m2
     
  • Link  Risk of acute pancreatitis:MHRA update Sept 12
       
    06.01.02.03  Expand sub section  DPP-4 inhibitors
    06.01.02.03  Expand sub section  GLP-1 mimetics
    semaglutide (Ozempic)
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    Formulary
    Green
     
       
    06.01.02.03  Expand sub section  SGLT2 inhibitors
    Ertugliflozin (Steglatro®)
    (5mg and 15mg tablets available)
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    Formulary
    Green

    NICE TA Guidance (TA572) recommends ertugliflozin as monotherapy or with metformin for treating type 2 diabetes in adults.

    Warning

     
    Link  Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes
       
     ....
     Non Formulary Items
    Linagliptin/ metformin  (Jentadueto®)

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    Non Formulary
     
    Liraglutide/Insulin Degludec  (Xultophy®)

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    Non Formulary
    Black
    Formulary application has been made but not presently prescribable on local NHS
    Not NHS The product is being considered in the Kent & Medway policy recommendation process.
    Link  Risk of Diabetic ketoacidosis when concomitant insulin reduced or stopped - MRHA warning
     
    Nateglinide  (Starlix®)

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    Non Formulary
     
    Pioglitazone and Metfomin  (Competact®)

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    Non Formulary




    STOPP v2 recommendation Thiazolidenediones (e.g. rosiglitazone, pioglitazone) inappropriate to use in patients aged 65 years and older with heart failure (risk of exacerbation of heart failure).
     
    Rosiglitazone  (Avandia®)

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    Non Formulary Withdrawn from clinical use





    STOPP v2 recommendation Thiazolidenediones (e.g. rosiglitazone, pioglitazone) inappropriate to use in patients aged 65 years and older with heart failure (risk of exacerbation of heart failure).
    Link  MHRA website
     
    Rosiglitazone and Metformin  (Avandamet®)

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    Non Formulary Withdrawn from clinical use





    STOPP v2 recommendation Thiazolidenediones (e.g. rosiglitazone, pioglitazone) inappropriate to use in patients aged 65 years and older with heart failure (risk of exacerbation of heart failure).
    Link  MHRA website
     
    Saxagliptin  (Onglyza®)

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    Non Formulary Warning
    1. Reduce dose to 2.5mg OD if eGFR 30-60 mL/min/1.73 m2
    2. Use with caution if eGFR < 30mL/min/1.73 m2
    Link  Risk of acute pancreatitis. MHRA safety update Sept 12
    Link  Serious hypersensitivity reactions & acute pancreatitis - Dear HCP Letter
     
    Sitagliptin and Metformin  (Janumet®)

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    Non Formulary
     
    Vildagliptin

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    Non Formulary WarningReduce dose to 50mg OD if eGFR < 50mL/min/1.73 m2
     
      
    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

    Amber

    Requires to be initiated by specialist for repeat GP Prescribing (Purple as per Eclipse East Kent Primary Care Formulary, may be top sliced) If a downloadable EKPG Prescribing Information Sheet exists in the formulary entry for the drug, it, or an URL (shortcut to webpage/document) should be sent to the GP. See also "Hints in how to incorporate documents for medicines information into clinical communications to GPs".  

    Amber 1

    Shared Care (Orange as per Eclipse East Kent Primary Care Formulary). See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    Amber 2

    Shared Care and topsliced (Orange as per Eclipse East Kent Primary Care Formulary) See the Principles of Shared Care Agreements and Shared Care Agreements: Assessment against agreed Principles of Shared Care documents. If a downloadable template document exists in the formulary entry for this drug, it should be sent to the GP (and patient) once patient specific details are incorporated. See "Hints in how to incorporate shared care documents for medicines into clinical communications to GPs".  

    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  

    Blue

    No comment on drug in East Kent Primary Care Formulary (Blue as per Eclipse East Kent Primary Care Formulary)  

    Brown

    Exceptional Use Only (Brown as per Eclipse East Kent Primary Care Formulary)   

    Green

    On East Kent Primary Care Formulary (Pink or Green as per Eclipse East Kent Primary Care Formulary)  

    Grey

    Not assessed/Not recommended (As per Eclipse East Kent Primary Care Formulary)  

    Red

    Hospital Only (As per Eclipse East Kent Primary Care Formulary)  

    RedRed

    Known to be commissioned for local NHS patients but only available to them from another provider than EKHUFT  

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