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 Formulary Chapter 6: Endocrine system - Full Chapter
06.01.02.03  Expand sub section  Other antidiabetic drugs
06.01.02.03  Expand sub section  Alpha glucosidase inhibitors
06.01.02.03  Expand sub section  DPP4 inhibitors (gliptins)
06.01.02.03  Expand sub section  SGLT2 inhibitors
Dapagliflozin (Forxiga▼®)
(SGLT-2 inhibitor, Tablets)
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Green

 

  • In line with NICE TA288, NICE TA390 and NICE TA418,
    Triple therapy in combination with metformin and a sulfonylurea.  Dual therapy in combination with metformin only if glycaemic control is inadequate, and patient has a significant risk of hypoglycaemia OR if sulfonylurea contraindicated or not tolerated.  In combination with insulin (alone or with other antidiabetic drugs)  As monotherapy in patients who cannot tolerate metformin or where metformin, pioglitazone and sulfonylureas are inappropriate as an alternative to a dipeptidyl peptidase 4 (DPP-4) inhibitor.
  • Notes on licensing:
    • Licensed for initiation in adults between 18 and 75 years only.
    • Should not be initiated in patients with a glomerular filtration rate [GFR] < 60 mL/min and should be discontinued at GFR persistently below 45 mL/min.
    • Due to its mechanism of action, patients taking dapagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.
  • SPECIALIST INITIATION with prescribing to be continued in Primary Care in line with NICE TA597 - Dapagliflozin with insulin for treating type 1 diabetes.  Primary care may continue to supply treatment following the initiation and first months supply are provided by secondary care/consultant led diabetes clinic. Patient's to be reviewed for continued need in line with NICE TA597 at 6 months by secondary care/consultant led diabetes clinic. 
 
Link  MHRA Drug Safety Update March 2020: SGLT2 inhibitors - monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
Link  MHRA: risk of diabetic ketoacidosis with SGLT2 inhibitors (June 2015)
Link  NICE TA288: Dapagliflozin in combination therapy for treating type 2 diabetes
   
Empagliflozin (Jardiance▼®)
(SGLT-2 inhibitor, Tablets)
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  • Approved as per NICE TA336 and NICE TA390

  • Dual therapy in combination with metformin, only if: a sulfonylurea is contraindicated or not tolerated, or the person is at significant risk of hypoglycaemia or its consequences  Triple therapy regimen in combination with: metformin and a sulfonylurea or metformin and a thiazolidinedione.  In combination with insulin (alone or with other antidiabetic drugs)  As monotherapy in patients who cannot tolerate metformin or where metformin, pioglitazone and sulfonylureas are inappropriate as an alternative to a dipeptidyl peptidase 4 (DPP-4) inhibitor


  • Licensed for initiation in adults aged 18years to 85years.

  • Maximum dose is 10mg daily in patients with GFR <60ml/min and should not be used if GFR is <45ml/min.

  • Due to its mechanism of action, patients taking empagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.

 
Link  MHRA Drug Safety Update March 2020: SGLT2 inhibitors - monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
Link  MHRA: risk of diabetic ketoacidosis with SGLT2 inhibitors (June 2015)
Link  NICE TA336: Empagliflozin for type 2 diabetes
   
Canagliflozin (Invokana▼®)
(SGLT2 inhibitor, Tablets)
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  • In line with NICE TA315 and NICE TA390, only if triple therapy indicated
    Triple therapy in combination with metformin and either a sulfonylurea or pioglitazone  Dual therapy in combination with metformin, only if a sulfonylurea is contraindicated or not tolerated OR the patient has a significant risk of hypoglycaemia In combination with insulin (alone or with other drugs).  As monotherapy in patients who cannot tolerate metformin or where metformin, pioglitazone and sulfonylureas are inappropriate as an alternative to a dipeptidyl peptidase 4 (DPP-4) inhibitor
    Notes on licensing:

  • Licensed for initiation in adults aged over 18years.

  • Maximum dose is 100mg daily in patients with GFR <60ml/min and should not be used if GFR is <45ml/min.

  • Due to its mechanism of action, patients taking canagliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.

 
Link  MHRA Drug Safety Update March 2020: SGLT2 inhibitors - monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
Link  MHRA: risk of diabetic ketoacidosis with SGLT2 inhibitors (June 2015)
Link  NICE TA315: Canagliflozin for type 2 diabetes
   
Ertugliflozin (Steglatro®)
(Tablets)
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  • Approved for use in accordance with NICE TA572 - Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes. 

    • Dual therapy in combination with metformin, only if: a sulfonylurea is contraindicated or not tolerated, or the person is at significant risk of hypoglycaemia or its consequences  As monotherapy in patients who cannot tolerate metformin or in whom metformin is contraindicated, only if a dipeptidyl peptidase 4 (DPP-4) inhibitor would otherwise be prescribed and a sulfonylurea or pioglitazone is not appropriate. 



  • Approved for use in accordance with NICE TA583 - Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes.

    • Ertugliflozin with metformin and a dipeptidyl peptidase‑4 (DPP‑4) inhibitor is recommended as an option for treating type 2 diabetes in adults when diet and exercise alone do not provide adequate glycaemic control, only if: the disease is uncontrolled with metformin and a DPP‑4 inhibitor, and a sulfonylurea or pioglitazone is not appropriate.




Notes on licensing:


 


  • Licensed for initiation in adults aged over 18years.

  • Initiation of this medicine is not recommended in patients with eGFR <60ml/min. 

  • Due to its mechanism of action, patients taking ertugliflozin will test positive for glucose in their urine and are at increased risk of urinary tract infection.

 
Link  MHRA Drug Safety Update March 2020: SGLT2 inhibitors - monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
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
   
06.01.02.03  Expand sub section  GLP1 agonists to top
06.01.02.03  Expand sub section  Thiazolidinediones
 ....
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

OTC

Available Over the Counter. Consider Self Care   

Green

Formulary - Can be prescribed in both secondary and primary care.   

Advice

Formulary - Specialist Advice, secondary care advice provided for primary care initiation.  

Amber No SCG

Formulary - Specialist initiation without shared care guidance.  

Amber SCG

Formulary - Specialist initiation with shared care guidance.  

Red Hospital

Restricted - Hospital only, not to be prescribed in primary care.  

Switch

Not recommended for prescribing. Switch to alternative cost-effective option.   

Black

Not recommended for prescribing in primary or secondary care.  

Grey

Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.   

Non Formulary

Non-Formulary (category under review).  

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