6.3.1.4 Other Diabetic Drugs
*SUPPLY ISSUE: The supplies of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) continue to be limited, with supplies currently not expected to return to normal until at least the end of 2024. Please see the SPS medicines supply tool (free subscription required) for the current stock situation and anticipated re-supply dates.
**There has been an updated Medicine Supply Notification (MSN/2024/031) on the supply issues of GLP-1 RAs released on the 18th March 2024, which supersedes the National Patient Safety Alert (NPSA) (NatPSA/2024/001/DHSC) released on the 3rd of January 2024. Please refer to the MSN/SPS medicines supply tool for further information, actions required and clinical guidance/advice on alternatives.**
*Please see information under each individual drug monograph below for further preparation specific information.*
Please note that lixisenatide (Lyxumia), all strengths, are now discontinued from December 2023. Byetta (exenatide), all strengths, will be discontinued at the end of March 2024. Please review patients prescribed Lyxumia or Byetta in line with the MSN.
Please prescribe GLP-1 RAs for licensed indications only, prescribe by brand, do not switch between strengths of a GLP-1 RA solely based on availability, do not double up a lower dose preparation where a higher dose preparation is not available, and check quantity prescribed (do not prescribe in quantities greater than one month).*
NHS Kent and Medway Integrated Care Board (ICB) does not support the off-label use (including weight loss) of Ozempic or other GLP-1 (glucagon-like peptide 1) receptor agonists (GLP-1 RAs) outside of product licenses.
At this time, it is imperative that all GLP-1 RAs (prescribed by brand) are ONLY prescribed for the treatment and management of type 2 diabetes. This is in the interest of patient safety for existing patients already on these medications. For Position Statement Click Here
For information on Wegovy (semaglutide) and Saxenda (liraglutide) in obesity Click Here
Drug safety update: SGLT2 inhibitors (Canagliflozin, Dapagliflozin, Empagliflozin) risk of diabetic ketoacidosis.
For more information Click Here (pdf)
For SGLTi Top Tips Click Here
For SPS Guidance on Pioglitazone monitoring in Adults in Primary Care please Click Here
Dapagliflozin -Â Type 2 Diabetes
For NICE Guideline NG28Â Type 2 diabetes in adults: management Click Here
Dapligliflozin - Chronic Kidney Disease (CKD) in AdultsÂ
For Primary Care Guidance -Dapagliflozin for Chronic Kidney Disease (CKD) in Adults and NICE TA775 Dapagliflozin for treating chronic kidney disease Click Here
Finerenone - Option for treating stage 3 and 4 chronic kidney disease (with albuminuria) associated with type 2 diabetes in adults (only for this indication).
For NICE TA 877 Finerenone for treating chronic kidney disease in type 2 diabetes Click Here
For Finerenone - 2.5.1. Potassium-Sparing Diuretics (Aldosterone antagonists) Click Here Â
| Pack |
|---|
| 100 tablet |
| 28 tablet |
| 30 tablet |
| Pack |
|---|
| 28 tablet |
| Pack |
|---|
| 28 tablet |
| Pack |
|---|
| 100 tablet |
| 30 tablet |
| 90 tablet |
| Pack |
|---|
| 100 tablet |
| 30 tablet |
| 90 tablet |
| Pack |
|---|
| 28 tablet |
| Pack |
|---|
| 28 tablet |
| Pack |
|---|
| 28 tablet |
Primary care initiation must be supplemented with the addition of the indication (Heart failure with reduced ejection fraction/Type 2 diabetes mellitus/Chronic Kidney Disease) for initiation in the consultation notes / medication screen & linked to associated problem.
| Pack |
|---|
| 28 tablet |
| Pack |
|---|
| 28 tablet |
During the ongoing national supply issues with GLP-1 RAs, new patients should not be initiated on Trulicity (injectable dulaglutide). Please see "SUPPLY ISSUE" information at the top of this page for more information and guidance.
The SPC recommends the higher doses of 3.0mg and 4.5 mg are used where additional glycaemic control is needed. A four-week interval is needed at least before increasing between the 1.5mg up to 3mg and 4.5mg. The titration should be carried out by a healthcare professional familiar with the prescribing and monitoring needed for GLP-1 mimetics.
| Pack |
|---|
| 4 pre-filled disposable injection |
| Pack |
|---|
| 4 pre-filled disposable injection |
| Pack |
|---|
| 4 pre-filled disposable injection |
| Pack |
|---|
| 4 pre-filled disposable injection |
Victoza (injectable liraglutide) is out of stock until the end of 2024. Please see "SUPPLY ISSUE" information at the top of this page for more information and guidance.
| Pack |
|---|
| 2 pre-filled disposable injection |
| 3 pre-filled disposable injection |
| Pack |
|---|
| 28 tablet |
| Pack |
|---|
| 28 tablet |
| Pack |
|---|
| 28 tablet |
During the ongoing national supply issues with GLP-1 RAs, new patients should not be initiated on Ozempic (injectable semaglutide). Please see "SUPPLY ISSUE" information at the top of this page for more information and guidance.
Please note that there are restrictions on the prescribing of Rybelsus (semaglutide tablets), which should only be prescribed in line with the MSN and NICE guidance.
When to use Semaglutide over other GLP1s:
1. In patients with established cardiovascular disease or CV risk
2. Patients with CKD
3. Type 2 with a compelling need to promote weight loss.
| Pack |
|---|
| 30 tablet |
| Pack |
|---|
| 30 tablet |
| Pack |
|---|
| 30 tablet |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
Tirzepatide -
(Glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 (GLP-1) receptor agonist)For treating type 2 diabetes in line with NICE TA924. For specialist initiation with specialist defined as secondary care prescribers, GPs, Specialist DSNs, and specialist pharmacists or nurses in primary care (e.g. practice or spoke nurses) who have completed PITstop or equivalent.
- Prescribing tirzepatide for weight loss is not clinically supported or funded by Kent and Medway ICB until NICE have evaluated its use for this indication.
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
| Pack |
|---|
| 1 pre-filled disposable injection |
- First Line Choice
- On Formulary
- Specialist Initiation Only
- Hospital Only
- KMPT Initiation Only