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Milton Keynes Formulary
Milton Keynes University Hospital NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes Clinical Commissioning Group
Milton Keynes Community Health Services
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 Formulary Chapter 6: Endocrine system - Full Chapter
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06.01.02.03  Expand sub section  Other antidiabetic drugs
Canagliflozin / metformin IR (Vokanamet)
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Formulary
Amber 2

Vokanamet® Tablets f/c 50mg/850mg, 50mg/1g

 

 
Link  MHRA Drug Safety Update: Canagliflozin (Invokana▼, Vokanamet▼): signal of increased risk of lower extremity amputations observed in trial in high cardiovascular risk patients
Link  NICE TA315: Canagliflozin in combination therapy for treating type 2 diabetes (June 2014)
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes (May 2016)
   
Dapagliflozin / metformin (Xigduo)
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Formulary
Amber 2

Xigduo® Tablets 5mg/850mg, 5mg/1g

 

 
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 and Metformin (Synjardy)
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Formulary
Amber 2

Synjardy® Tablets f/c 5mg/850mg, 5mg/1000mg, 12.5mg/850mg,
12.5mg/1000mg

 

 
Link  NICE TA336: Empagliflozin in combination therapy for treating type 2 diabetes (March 2015)
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes (May 2016)
   
Repaglinide (Prandin)
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Formulary
Green

Tablets 500mcg, 1mg, 2mg

 
   
06.01.02.03  Expand sub section  Alpha glucosidase inhibitors
Acarbose (Glucobay)
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Formulary
Green

Tablets 50mg, 100mg

 

Note: Acarbose should be taken or chewed with the first mouthful of food or swallowed whole with liquid immediately before food. The possibility of GI side effects is reduced by lower incremental dosage increases

 
   
06.01.02.03  Expand sub section  DPP4 inhibitors (gliptins)
Sitagliptin (Januvia)
(DPP4 inhibitor)
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Formulary
Green

Tablets 25mg, 50mg, 100mg

 
   
Sitagliptin and Metformin (Janumet)
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Formulary
Green

Janumet tablets 50mg /1 gram

 
   
Linagliptin (Trajenta)
(DPP4 inhibitor)
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Formulary
Green

Tablets 5mg

 
   
Linagliptin/ metformin (Jentadueto)
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Formulary
Green

Jentadueto® Tablets 2.5mg/850mg, 2.5mg/1g

 
   
06.01.02.03  Expand sub section  GLP1 agonists
Exenatide (Byetta)
(GLP1 agonist)
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Formulary
Amber 2

Byetta® Injection 250mcg/mL

 
Link  MRHA warning on risk of acute pancreatitis and renal failure (2009)
   
Liraglutide (Victoza)
(GLP1 agonist)
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Formulary
Amber 2

This brand is licensed for the treatment of type 2 diabetes mellitus only (not for managing overweight and obesity).

 

6mg/ml solution for injection, 3ml pre-filled pens (disposable injection)

 

 

 
   
Lixisenatide (Lyxumia)
(GLP1 agonist)
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Formulary
Amber 2

Lyxumia® Injection, 50micrograms/mL (10micrograms/dose prefilled pen),
100micrograms/mL (20 micrograms/dose prefilled pen.

Notes:
 
  • Prescribers should consider stopping Lixisenatide when HbA1c has not reduced by 1% and weight by 3% of initial body weight at 6 months  
 
   
Dulaglutide (Trulicity)
(GLP1 agonist)
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Formulary
Amber 2

Trulicity® Injection 0.75mg, 1.5mg

Notes:

 
Link  NICE: Evidence Summary (ESNM59)
   
Liraglutide (Saxenda)
(GLP1 agonist)
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Formulary
Red

This brand is licensed for weight management only (not for type 2 diabetes mellitus).

6mg/ml solution for injection, 3ml pre-filled pens (disposable injection)

Note:

  • To be used as an adjunct in weight management and obesity in conjunction with dietary measures and increased physical activity in adults, in line with the NICE TA guidance (see link below).
  • CCG commissioned, however NICE TA664 covers the management of obesity and non-diabetic hyperglycaemia in a specialist weight management (tier 3) service which is unavailable in MK.
  • GPs can refer patients to the Luton & Dunstable Tier 3 service using the referral form below.
 
 
Link  NICE TA664: Liraglutide for managing overweight and obesity
Link  Specialist Weight Management Obesity/Bariatric Service Referral Form
   
SemaglutideBlack Triangle (Ozempic)
(Injection)
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Formulary
Amber 2
  • Ozempic® 0.25 mg solution for injection in pre-filled pen
  • Ozempic® 0.5 mg solution for injection in pre-filled pen
  • Ozempic® 1 mg solution for injection in pre-filled pen
 
   
SemaglutideBlack Triangle (Rybelsus)
(Oral tablet)
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Formulary
Amber 1

3 mg, 7mg and 14mg tablets 

 

Rybelsus® is indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus to improve glycaemic control as an adjunct to diet and exercise:

  • as monotherapy when metformin is considered inappropriate due to intolerance or contraindications
  • in combination with other medicinal products for the treatment of diabetes.

Amber 1 for patients new to Semaglutide,

Amber 3 for those already on Semaglutide injection where it is necessary to switch over from the injection to the oral tablet form.

 
   
06.01.02.03  Expand sub section  Meglitinides to top
06.01.02.03  Expand sub section  SGL2 inhibitors
Empagliflozin (Jardiance)
(SGLT-2 inhibitor)
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Formulary
Amber 2

Jardiance® Tablets 10mg, 25mg

 
Link  MHRA Drug Safety Updates (Mar 2017, Feb 2019)
Link  NICE TA336: Empagliflozin for type 2 diabetes
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating T2D
   
Canagliflozin (Invokana)
(SGLT2 inhibitor)
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Formulary
Amber 2

Invokana® Tablets 100mg, 300mg

 
Link  MHRA Drug Safety Updates (Mar 2017, Feb 2019)
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes (May 2016)
Link  NICE TA315: Canagliflozin for type 2 diabetes (June 2014)
   
Dapagliflozin (Forxiga)
(SGLT-2 inhibitor)
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Formulary
Amber 2

Forxiga® Tablets 5mg, 10mg

Note:

  • Evidence-based recommendations on dapagliflozin with insulin for treating type 1 diabetes not controlled by insulin therapy alone in adults with a body mass index (BMI) of at least 27 kg/m2. See NICE TA597 below for further details.
 
Link  MHRA Drug Safety Updates (Mar 2017, Feb 2019)
Link  NICE TA288: Dapagliflozin in combination therapy for treating T2D
Link  NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating T2D
Link  NICE TA418: Dapagliflozin in triple therapy for treating type 2 diabetes
Link  NICE TA597: Dapagliflozin with insulin for treating T1D
   
ErtugliflozinBlack Triangle (Steglatro)
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Formulary
Amber 2

Tablets 5mg, 15mg

 
Link  MHRA Drug Safety Updates (Mar 2017, Feb 2019)
Link  NICE TA572: Ertugliflozin as monotherapy or with metformin for treating T2D (March 2019)
Link  NICE TA583: Ertugliflozin with metformin and a DPP4i for treating T2D (June 2019)
   
Sotagliflozin (Zynquista)
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Formulary
Amber 2

200mg film-coated tablets

Use in line with NICE guidance (see link below).

 
Link  NICE TA622: Sotagliflozin with insulin for treating type 1 diabetes (February 2020)
   
06.01.02.03  Expand sub section  Thiazolidinediones
Pioglitazone (Actos)
(Thiazolidinedione)
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Formulary
Amber 2

Tablets 15mg, 30mg, 45mg

Cases of cardiac failure have been reported when pioglitazone was used in combination with insulin, especially in patients with risk factors for the development of cardiac failure.

If the combination is used, patients should be observed for signs and symptoms of heart failure, weight gain and oedema.

Pioglitazone should be discontinued if any deterioration in cardiac status occurs.

 

 
Link  Risk of bladder cancer: MHRA safety update
Link  Risk of cardiac failure when combined with insulin (MHRA safety update Jan 2011)
   
 ....
 Non Formulary Items
Albiglutide  (Eperzan)

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Non Formulary
 
Alogliptin  (Vipidia)

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Non Formulary
 
Alogliptin / metformin  (Vipdomet)

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Non Formulary
 
Alogliptin / pioglitazone  (Incresync)

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Non Formulary
 
Empagliflozin + linagliptin  (Glyxambi)

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Non Formulary
 
Ertugliflozin + metformin  (Segluromet)

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Non Formulary
 
Ertugliflozin + sitagliptin  (Steglujan)

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Non Formulary
 
Exenatide prolonged release  (Bydureon)
(GLP1 agonist)

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Non Formulary
Amber 2
Link  NICE TAG 248- MR exenatide
Link  Pancreatic problems with GLP-1 medicines - MHRA statement 2013
 
Lixisenatide+ insulin glargine  (Suliqua)

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Non Formulary
 
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
Link  MHRA withdrawal information
 
Rosiglitazone and Metformin  (Avandamet)

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Non Formulary
 
Saxagliptin  (Onglyza)

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Non Formulary
Link  Risk of acute pancreatitis. MHRA safety update Sept 12
 
Saxagliptin and dapagliflozin  (Qtern)

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Non Formulary
 
Saxagliptin and metformin  (Komboglyze)

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Non Formulary
 
Vildagliptin

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Non Formulary
 
Vildagliptin and Metformin  (Eucreas)

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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
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
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

Green

Routine prescribing within licensed indication  

Amber 1

Specialist recommendation followed by GP initiation and continuation  

Amber 2

Specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation   

Amber 3

Specialist initiation and stabilisation followed by GP continuation  

Amber SCG

Specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline  

Red

Hospital or specialist prescribing only  

Red Red

These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.  

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