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Guy's and St Thomas' NHS Foundation Trust
Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 6: Endocrine system - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

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06.01.02.03  Expand sub section  Other antidiabetic drugs
06.01.02.03  Expand sub section  Alpha glucosidase inhibitors
Acarbose tabs
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Formulary  
   
06.01.02.03  Expand sub section  GLP-1 mimetics
Dulaglutide injection
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Formulary
Amber 3

Follow SE London APC GLP-1 guidance for criteria for use

Initiation by specialist only.

Ongoing supplies can be requested from primary care after the 3 months review using the transfer of care document (links below)

 
Link  SE London APC recommendation: Dulaglutide for Type 2 diabetes
   
Liraglutide injection
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Formulary
Amber 3

Follow SE London APC GLP-1 guidance for criteria for use

Initiation by specialist only.

Ongoing supplies can be requested from primary care after the 3 months review using the transfer of care document (links below)

 
   
Semaglutide injection
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Formulary
Amber 3

Follow SE London APC GLP-1 guidance for criteria for use

Initiation by specialist only.

Ongoing supplies can be requested from primary care after the 3 months review using the transfer of care document (links below)

 
Link  SE London APC recommendation: Semaglutide (Ozempic™) 0.25mg, 0.5mg and 1mg solution for injection in a pre-filled pen for type 2 diabetes mellitus
   
06.01.02.03  Expand sub section  DPP4 inhibitors (gliptins)
Linagliptin tabs
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Restricted Drug Restricted Reserved for use in patients with severe renal impairment (eGFR <30 mL/min) 
   
Sitagliptin tabs
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Formulary  
   
06.01.02.03  Expand sub section  SGLT2 inhibitors to top
Canagliflozin tabs
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Formulary
Green
 
Link  MHRA Advice - SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis, April 2016
Link  MHRA Mar 2017: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation
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 tabs (type 1 diabetes)
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Formulary
Red

Approved as per NICE technology appraisal guidance (see link below)

Specialist diabetologist recommendation only

Currently for hospital prescribing only.  Formal ongoing supply arrangements being reviewed by the APC.

 
Link  MHRA Apr 2016: SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
Link  MHRA Mar 2017: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes)
Link  NICE TA597: Dapagliflozin with insulin for treating type 1 diabetes
   
Dapagliflozin tabs (type 2 diabetes)
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Formulary
Green

Approved as per NICE technology appraisal guidance (see links below)

 
Link  MHRA Advice - SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis, April 2016
Link  MHRA Mar 2017: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation
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
   
Empagliflozin tabs
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Formulary
Green
 
Link  MHRA Advice - SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis, April 2016
Link  MHRA Mar 2017: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation
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 tabs
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Formulary
Green

 

 
Link  MHRA Advice - SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis, April 2016
Link  MHRA Mar 2017: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation
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 tabs (type 1 diabetes)
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Formulary
Red

Approved as per NICE technology appraisal guidance (see links below)

 
Link  NICE TA622: Sotagliflozin with insulin for treating type 1 diabetes
   
06.01.02.03  Expand sub section  Meglitinides
Repaglinide tabs
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Formulary  
   
06.01.02.03  Expand sub section  SGL2 inhibitors
06.01.02.03  Expand sub section  Other
06.01.02.03  Expand sub section  Thiazolidinediones
Pioglitazone tabs
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Formulary  
Link  MHRA Advice - Insulin combined with pioglitazone: risk of cardiac failure, January 2011
Link  MHRA Advice - Pioglitazone: risk of bladder cancer, August 2011
   
 ....
 Non Formulary Items
Exenatide injection, prolonged release injection

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Non Formulary
Grey

No longer approved for initiation in new patients in SE London.

 
Lixisenatide injection

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Non Formulary
Grey

No longer approved for initiation in new patients in SE London.

 
  
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 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

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

Amber 1

Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

Amber 2

Specialist initiation followed by maintenance prescribing in primary care  

Amber 3

Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

Green

Specialist and non-specialist initiation  

Grey

Not recommended for prescribing  

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