Formulary Chapter 6: Endocrine system - Full Chapter
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06.01 |
Drugs used in diabetes |
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These Audit tools have been developed by the North West Sussex Medicines Management team to support clinically effective prescribing. They are intended to be used as an aid for practice staff to review patients in line with national guidance, and may be amended to suit individual practice or clinician preferences. They are published as simple Microsoft Word documents to enable easy adaptation.
The information contained in the audit tools is correct at the time of production. Using them does not remove any of the professional obligations to prescribe safely by taking individual patient factors into consideration and clinician discretion with individual patients during the review process is essential. Staff using these audits must concurrently take full account of the practice’s internal governance and quality assurance policies, and work in line with the Data Protection Act 1998.
Audits - please click the link below
Hypoglycaemic Agents
Treatment to control blood glucose must be tailored to each individual patient’s clinical needs with safety paramount. It is generally agreed, and supported by the NICE guideline on type 2 diabetes, that metformin should be used first line and a sulfonylurea second line, unless contraindicated.
The newer hypoglycaemic drugs are all usually third-line options – although effective at reducing HbA1c levels, they all lack robust clinical outcome data, particularly around their cardiovascular effects and long term safety in people with type 2 diabetes. Improvements in surrogate markers (e.g. HbA1c levels) do not automatically confer benefits on patient mortality or morbidity, and risks may become apparent only over time when these agents have more widespread use in a diverse patient population.
This audit tool supports the review of newer hypoglycaemic agent prescribing for patients with Type 2 diabetes to ensure these agents are initiated and continued in accordance with NICE and local guidelines. |
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06.01.01 |
Insulins |
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06.01.01.01 |
Short-acting insulins |
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Insulin Aspart (FIASP®)
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Formulary
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100units per ml solution for injection
Indication - Diabetes Mellitus in Adults not licensed for under 18 years
Pre-filled Pen
Cartridge
Vial
Diabetologist initiation only
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PCN 271-2017 Fast acting insulin aspart (Fiasp®) for the treatment of diabetes mellitus in adult patients
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Insulin Aspart (NovoRapid®)
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Formulary
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PumpCart®Solution for injection in cartridge, 1 cartridge contains 1.6 ml equivalent to 160 units To be used with insulin pump only
Pre-filled pen, Penfil cartridges
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Insulin Glulisine (Apidra®)
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Formulary
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Indication - Diabetes Mellitus
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Insulin Lispro (Humalog®)
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Formulary
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Indication - Diabetes Mellitus
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06.01.01.01 |
Soluble Insulin |
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Soluble Insulin (Actrapid ®)
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Formulary
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Soluble Insulin (Humulin S ®)
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Formulary
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06.01.01.01 |
Rapid Acting Insulin Analogues |
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06.01.01.02 |
Intermediate- and long-acting insulins |
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Insulin Degludec (Tresiba®) (Type 1 and 2 diabetes )
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Formulary
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100units/mL & 200units/mL
Only for use in Type 1 diabetics who meet the criteria.
For Consultant initiation only
Documented severe hypoglycaemia
Risk of hypoglycaemia because of reduced awareness; or Frequent hypoglycaemia which prevents achieving predefined glycaemic targets
AND individuals should have:
Received an appropriate level of education with respect to flexible insulin dosing and carbohydrate counting; and
Tried other basal insulin regimens including split dose Determir as recommended in NG17
Be prepared to complete hospital issued assessment questionnaire
This decision is based on Brighton APC decision
Only for use in Type 2 diabetics who meet the criteria.
For Consultant initiation only in those poorly controlled patients:
Who do not reach their target HbA1c because of significant hypoglycaemia OR
Who experience significant hypoglycaemia on Neutral Protamine Hagedorn (NPH) and insulin detemir or glargine (100units/ml) irrespective of the level of HbA1c OR
Who cannot use the device needed to inject NPH and insulin detemir or glargine (100units/ml) but who could administer their own insulin safely and accurately if a switch to one of the long acting insulin analogues was made OR
Who need help from a carer or healthcare professional to administer insulin injections and for whom having a wide window for daily administration is essential. A minimum of 8 hours between injections should always be ensured.
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MHRA Drug Safety Update Apr 2013 Degludec available in additional higher strengths than existing insulins – care needed to minimise risk of error, including training for patients
PCN 217-2016 Degludec in Type 2 Diabetes (updated April 2017)
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Insulin Glargine (Lantus®)
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Formulary
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100 units/mL SoloStar prefilled pen; vial; cartridge
Indication - Diabetes (type 1 and 2) Not for routine use in type 2 diabetics. Type 2's must fall into NICE criteria for eligibility.
Prescribe by brand
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MHRA Drug Safety Update 29/04/2015 - High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error
NICE TA53 - Guidance on the use of long‑acting insulin analogues for the treatment of diabetes – insulin glargine
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Insulin Glargine (Toujeo®)
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Formulary
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When prescribing please specify pen size needed as indicated below:
Solostar 1.5ml Pre-filled Pens total 450units per pen
Doublestar 3ml Pre-filled Pens total 900units per pen
- 300units/ml
- Indication -
Type 1 Diabetes Type 2 Diabetes
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PCN Statement 181-2016 Toujeo (insulin glargine 300units/ml) Type 1 diabetes
PCN statement 182-2016 Toujeo (insulin glargine 300 units/ml) Type 2 diabetes
MHRA Drug Safety Update 29/04/2015 - High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error
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Insulin Glargine Biosimilar (Abasaglar®)
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Formulary
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100 units/mL solution for injection; pre-filled pen; cartridge Indication
Diabetes Type I in line with NICE NG17 and PCN statement 199-2016Diabetes Type II in line with NICE NG28 and PCN statement 200-2016
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NG17 Type 1 diabetes in adults: diagnosis and management
NG28 Type 2 diabetes in adults: management
PCN 199-2106 Abasaglar (Insulin Glargine- Biosimilar) for the treatment of Type I diabetes mellitus in adults, adolescents and children aged 2 years and above.
PCN 200-2016 Abasaglar (Insulin Glargine- Biosimilar) for the treatment of Type II diabetes mellitus in adults, adolescents and children aged 2 years and above.
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Isophane Insulin (Humulin® I)
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Formulary
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Indication - Diabetes MellitusFirst line choice under specialist initiation
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Isophane Insulin (Insulatard®)
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Formulary
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Indication - Diabetes Mellitus
First line choice under specialist initiation
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Isophane Insulin (Insuman® Basal)
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Formulary
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Indication - Diabetes Mellitus
First line choice under specialist initiation
Temporary shortage supply of Insulin human - INSUMAN® Basal.
No new patients should be started on Insuman® Basal(prefilled pens and cartridges) during the shortage and existing patients should be switched to a suitable alternative. (see link below)
Shortage also affects INSUMAN® Comb 25 (prefilled pens and cartridges)
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EMEA Shortage of Insuman Basal and Comb 25 (insulin human)
Sanofi letter Shortage of Insuman Basal and Comb 25
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Insulin Detemir (Levemir®)
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Formulary
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Indication - Diabetes Mellitus
Second line choice under specialist initiation
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NICE TA53 - Guidance on the use of long‑acting insulin analogues for the treatment of diabetes – insulin glargine
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Insulin 500 units in 1mL (Humulin R®U-500)
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Formulary
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Indication - Diabetes
unlicensed
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Insulin Pump
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Formulary
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Continuous subcutaneous infusion
- Indications
- Diabetes Type 1 (adults & children)in line with NICE TA151
- for children and young people with a non-autoimmune cause for deficiency of beta cells (who do not have type 1 diabetes) TA151
Prescribing of the pump and consumables would be by hospital specialists only (RED), in line with NICE, using the Blueteq initiation and continuation forms.
Insulin for use in the pump would continue to be prescribed by the individual patient’s GP

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APC 470-2019 Omnipod DASH system (002)
MHRA Medical Device Alert Feb 2019 - Accu-Chek Insight insulin pumps
PCN 334-2018 Insulin pumps for all age groups with a non-autoimmune cause for deficiency of beta cells
APC 389-2019 Commissioning of insulin pumps
MHRA Medical Device Alert - Sep 2017 - All Accu-Chek Insight Insulin pumps - risk of alarm failure
Minimed 640G (Medtronic) Insulin Pump for patients with Type 1 Diabetes - PCN 158-2015 - May 2015
NICE TA151 - Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus
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06.01.01.02 |
Biphasic insulins |
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Biphasic Insulin Aspart (NovoMix® 30)
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Formulary
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Indication - Diabetes Mellitus
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Biphasic Insulin Lispro (Humalog Mix 25)
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Formulary
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Indication - Diabetes Mellitus
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Biphasic Insulin Lispro (Humalog Mix 50)
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Formulary
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Indication - Diabetes Mellitus
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Biphasic Isophane Insulin (Humulin® M3)
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Formulary
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Indication - Diabetes Mellitus
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06.01.01.02 |
Intermediate Acting Insulin |
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06.01.01.02 |
Long Acting Insulin Analogues |
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06.01.01.03 |
Hypodermic equipment |
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Injection Devices (Autopen®24)
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Formulary
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For use with Sanofi-Aventis 3ml cartridges
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Injection Devices (Autopen®Classic)
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Formulary
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For use with Lilly 3ml cartridges
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Injection Devices (HumaPen® Luxura HD)
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Formulary
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HD 1-30 unit For use with Humulin® and Humalog® 3ml cartridges
Use HumanPen® Savvio as replacement for 1-60unit HumanPen® Luxura
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Injection Devices (HumaPen® Savvio)
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Formulary
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Injection Devices (NovoPen®4 )
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Formulary
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For use with Novo Nordisk 3ml cartridges
The manufacturer of NovoPen® 4 has written to healthcare professionals advising that this device is being phased out and replaced by NovoPen® 5.
It is expected that supplies of the NovoPen® 4 will run out in September 2015.
The new device will be available in the same colours (blue and silver) and has a memory function
You may view the latest post at
http://www.prescriber.org.uk/2015/07/novopen-4-to-be-phased-out/
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Needle free Insulin delivery system (Injex®)
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Formulary
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Administration of insulin to patients diagnosed with true needle-phobia
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Needle-free Insulin Devices - Policy Statement PCN 134-2015 - Feb 2015
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Needle free Insulin delivery system (Insujet®)
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Formulary
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Administration of insulin to patients diagnosed with true needle-phobia
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Needle-free Insulin Devices - Policy Statement PCN 134-2015 - Feb 2015
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Pen needles for insulin delivery
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Formulary
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The selected preferred cost-effective needles are those < £3 for 100 ;
- Microdot Max 4mm / 32G, 6mm / 31G
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CareFine 4mm / 32G, 5mm / 31G, 6mm / 31G, 8mm / 31G
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GlucoRx CarePoint 4mm / 31G, 5mm / 31G, 6mm / 31G, 8mm / 31G, 10mm / 29G, 12mm / 29G
- GlucoRx CarePoint Ultra 4mm / 32G
Safety Needles e.g. BD Auto-shield NOT TO BE Prescribed on FP10. Not to be prescribed for use by SCFT staff -
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06.01.02 |
Antidiabetic drugs |
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06.01.02.01 |
Sulphonyureas |
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Gliclazide
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First Choice
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Tablets
Indication - Type 2 Diabetes Mellitus
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Glipizide
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First Choice
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Tablets
Indication - Type 2 Diabetes Mellitus
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Gliclazide MR
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Second Choice
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Tablets
Indication - Type 2 Diabetes Mellitus
Reserved for patients with compliance issues who require a once a day treatment
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Glimepiride
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Second Choice
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Tablets
Indication - Type 2 Diabetes Mellitus
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06.01.02.02 |
Biguanides |
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Metformin
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First Choice
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Tablets, Oral Solution sugar free
- Oral solution for patients with swallowing difficulties only
- Use with caution in renal impairment—increased risk of lactic acidosis; avoid in significant renal impairment. NICE(1) recommends that the dose should be reviewed if eGFR less than 45 mL/minute/1.73 m2 and to avoid if eGFR less than 30 mL/minute/1.73 m2. Withdraw or interrupt treatment in those at risk of tissue hypoxia or sudden deterioration in renal function, such as those with dehydration, severe infection, shock, sepsis, acute heart failure, respiratory failure or hepatic impairment, or those who have recently had a myocardial infarction
- Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes TA572
- Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes TA583
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PCN 162 - 2015 - June 2015 - Metformin use in Renal Impairment
NICE 572 Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes
NICE 583 Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes
Type 2 diabetes in adults: management NG28
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Metformin Hydrochloride m/r
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Second Choice
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Tablets m/r Where GI complications with immediate release product
Use with caution in renal impairment—increased risk of lactic acidosis; avoid in significant renal impairment. NICE(1) recommends that the dose should be reviewed if eGFR less than 45 mL/minute/1.73 m2 and to avoid if eGFR less than 30 mL/minute/1.73 m2. Withdraw or interrupt treatment in those at risk of tissue hypoxia or sudden deterioration in renal function, such as those with dehydration, severe infection, shock, sepsis, acute heart failure, respiratory failure or hepatic impairment, or those who have recently had a myocardial infarction.
Sukkarto®SR
A cost-effective option
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PCN 162 - 2015 - June 2015 - Metformin use in Renal Impairment
Type 2 diabetes in adults: management NG28
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06.01.02.03 |
Other antidiabetic drugs |
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Liraglutide i/r, exenatide i/r and exenatide m/r can be initiated in triple therapy (with metformin and a sulfonylurea OR metformin and a thiazolidinedione) when HbA1c ≥ 7.5% / 58 mmol/mol (or higher as agreed with patient) and:
BMI ≥ 35kg/m2 (in patients of European descent – appropriate adjustment for other ethnic groups) and there are specific psychological/medical problems associated with high body weight or
BMI < 35kg/m2 and insulin therapy has significant occupational implications or weight loss would benefit other obesity-related co-morbidities
Treatment can be continued if there is a beneficial metabolic response (1% reduction in HbA1c and 3% weight loss in 6 months).
Liraglutide i/r and exenatide m/r can be initiated in dual therapy (with metformin or a sulfonylurea) when:
The patient is intolerant to metformin or sulfonylureas or treatment with metformin or a sulfonylurea is contraindicated and
The patient is intolerant to thiazolidinediones and DPP-4 inhibitors or treatment with thiazolidinediones and DPP-4 inhibitors is contraindicated.
Treatment can be continued if there is a beneficial metabolic response (1% reduction in HbA1c in 6 months).
Dipeptidylpeptidase 4 (DPP-4) inhibitors Continue DPP-4 inhibitors only if there is a reduction ≥ 0.5 percentage points in HbA1c within 6 months of starting treatment. Patients taking gliptins should be made aware of the symptoms of pancreatitis and to seek help if they develop. |
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Nateglinide
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Formulary
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Tablets
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Repaglinide
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Formulary
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Tablets
- Rapid onset of action and short duration of activity
- Consider a rapid-acting insulin secretagogue as an alternative to sulfonylurea if the person has an erratic lifestyle or meal pattern
- Licensed as monotherapy
- Licensed as dual therapy in combination with metformin
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Pioglitazone
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Formulary
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Tablets
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MHRA Drug Safety Update 01/2011 - Insulin combined with pioglitazone: risk of cardiac failure
MHRA Drug Safety Update 08/2011 - Pioglitazone: risk of bladder cancer
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06.01.02.03 |
DPP-4 inhibitors |
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Alogliptin
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Formulary
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TabletsIndication - Diabetes (type 2) - in accordance with NICE criteria for both initiation and continuation of therapy
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Type 2 diabetes in adults: management NG28
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Linagliptin
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Formulary
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Tablets
- For renal impairment only
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Drug Safety Update 09/2012 - Dipeptidylpeptidase-4 inhibitors: risk of acute pancreatitis
Type 2 diabetes in adults: management NG28
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Saxagliptin
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Formulary
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TabletsIndication - Diabetes (type 2) - in accordance with NICE criteria for both initiation and continuation of therapy
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Drug Safety Update 09/2012 - Dipeptidylpeptidase-4 inhibitors: risk of acute pancreatitis
Type 2 diabetes in adults: management NG28
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Sitagliptin
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Formulary
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Tablets
- Indication - Diabetes (type 2) - in accordance with NICE criteria for both initiation and continuation of therapy
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Drug Safety Update 09/2012 - Dipeptidylpeptidase-4 inhibitors: risk of acute pancreatitis
Type 2 diabetes in adults: management NG28
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Vildagliptin
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Formulary
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Tablets
Indication - Diabetes (type 2) - in accordance with NICE criteria for both initiation and continuation of therapy
Monitor liver function before and every 3 months during therapy due to rare reports of liver dysfunction
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Drug Safety Update 09/2012 - Dipeptidylpeptidase-4 inhibitors: risk of acute pancreatitis
Type 2 diabetes in adults: management NG28
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06.01.02.03 |
GLP-1 mimetics |
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Dulaglutide (Trulicity®)
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Formulary
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Indication Treatment option for type 2 diabetes in line with NICE (NG28)
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MHRA Drug Safety Update Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
NICE NG28 - Type 2 diabetes in adults: management
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Exenatide
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Formulary
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Injection (Byetta®), 2mg Prefilled Pen m/r (Bydureon®)
Indication - Type 2 diabetes (in line with NICE criteria for initiation and continuation).
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MHRA Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
Drug Safety Update 03/2009 - Exenatide (Byetta Ą): risk of severe pancreatitis and renal failure
NICE TA248 Exenatide prolonged-release suspension for injection in combination with oral antidiabetic therapy for the treatment of type 2 diabetes
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Liraglutide (Victoza®)
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Formulary
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Injection 6mg/ml
- Indication - Type 2 Diabetes
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MHRA Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
NICE NG28 Type 2 diabetes in adults: management
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Lixisenatide
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Formulary
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Injection
- Indication - Diabetes (type 2)
- Consider adding a GLP-1 mimetic 3rd line therapy when control of blood glucose remains or becomes inadequate. Only continue if beneficial metabolic response.
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MHRA Drug Safety Update Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
NICE NG28 - Type 2 diabetes in adults: management
PCN 73-2013 Lixisenatide for the treatment of type 2 diabetes mellitus
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Semaglutide (Ozempic®)
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Formulary
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Injection 0.25mg/0.19ml, 0.5mg/0.37ml, 1mg/0.74ml pre-filled pen
- Indication - Diabetes (type 2)
Not Approved for use in type 2 diabetic patients with inadequate glucose control despite lifestyle intervention and metformin if they have 9 of 9 established cardiovascular disease in accordance with joint ADA/EASD clinical practice guidelines
Surrey Area Precribing Committee (SAPC) have recommended this as BLACK on their formulary. APC 456-2019
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APC 456-2019 Semaglutide (Ozempic®) for treatment of adults with insufficiently controlled type 2 diabetes mellitus
MHRA Drug Safety Update Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
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06.01.02.03 |
SGLT2 inhibitors |
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Canagliflozin (Invokana)
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Third Choice
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Tablets
- Indication - Diabetes (type 2)
- Canagliflozin - an option for dual or triple therapy in type 2 diabetes.
- Monotherapy as per NICE TA390 Only if:
•a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and •a sulfonylurea or pioglitazone is not appropriate.
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MHRA Drug Safety Alert Feb 2019 SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
MHRA Druf Safety Update Apr 2016 SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
MHRA Drug Safety Update Jun 2016 Canagliflozin (InvokanaĄ, VokanametĄ): signal of increased risk of lower extremity amputations observed in trial in high cardiovascular risk patient
MHRA Drug Safety Update June 2015 SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis
MHRA Drug Safety update Mar 2017 SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes)
NICE TA315 - Canagliflozin in combination therapy for treating type 2 diabetes
NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
PCN 121-2014 Canagliflozin for the treatment of type 2 diabetes
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Dapagliflozin (Forxiga)
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Third Choice
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Tablets
Indication
- Type 2 diabetes (combination therapy, in line with NICE criteria for initiation and continuation)
- Monotherapy as per NICE TA390 Only if:
•a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and •a sulfonylurea or pioglitazone is not appropriate.
- Triple therapy regimen is recommended as an option for
treating type 2 diabetes in adults, only in combination with metformin and a sulfonylurea.TA418

- Indication - With insulin for treating type 1 diabetes (TA597)
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NICE TA597 - Dapagliflozin with insulin for treating type 1 diabetes
MHRA Drug Safety Alert Feb 2019 SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
MHRA Drug Safety Update Apr 2016 SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
MHRA Drug Safety Update June 2015 SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis
NICE TA288 - Dapagliflozin in combination therapy for treating type 2 diabetes
NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
NICE TA418- Dapagliflozin in triple therapy for treating type 2 diabetes- Nov 2016
PCN 72-2013 Dapagliflozin for the treatment of type 2 diabetes mellitus
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Empagliflozin (Jardiance▼®)
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Formulary
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Tablets
Combinations therapy as per NICE TA336
Monotherapy as per NICE TA390 Only if:
•a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
•a sulfonylurea or pioglitazone is not appropriate.
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MHRA Drug Safety Alert Feb 2019 SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum)
MHRA Drug Safety Update April 2016 SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
MHRA Drug Safety Update June 2015 SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis
NICE TA336 Empagliflozin in combination therapy for treating type 2 diabetes
NICE TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes
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Ertugliflozin (Steglatro®)
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Formulary
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Tablets
Indication - Type 2 diabetes in adults as per NICE TA572
Monotherapy when metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control, only if:
- a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
- a sulfonylurea or pioglitazone is not appropriate.
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
Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes TA583
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APC 405 - 2019 Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes (NICE TA572)
NICE TA572 Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes
NICE TA583 Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes
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Sotagliflozin (Zynquista®) (Not yet Available on the NHS expected early 2021)
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Formulary
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200mg Tablet
Indications
- Sotagliflozin with insulin for treating type 1 diabetes (TA622)
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NICE TA622 - Feb 20 - Sotagliflozin with insulin for treating type 1 diabetes
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06.01.02.03 |
Other |
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06.01.02.05 |
Glucagon-like peptide-1 receptor agonists - once weekly |
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06.01.02.07 |
Other antidiabetic drugs |
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06.01.03 |
Diabetic ketoacidosis |
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In patient procedures vary, please see local hospital policy |
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06.01.04 |
Treatment of hypoglycaemia |
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Glucagon 1mg powder and solvent (GlucaGen® HypoKit)
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First Choice
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Injection
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Glucose 40% oral gel (GlucoGel®)
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First Choice
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Glucose Oral Gel 3 x 25g
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Glucose powder
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Formulary
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06.01.04 |
Chronic hypoglycaemia |
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Diazoxide
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Formulary
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Funded by NHS England via specialist centres
CCGs commission ongoing prescription of drugs suitable for shared care
Suspension 250mg / 5ml
- Indication To treat Infants and Children with Congenital Hyperinsulinaemia, in combination with Chlorothiazide
unlicensed
- CPMAP agreed RED June 2017
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06.01.05 |
Treatment of diabetic nephropathy and neuropathy |
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06.01.05 |
Diabetic nephropathy |
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06.01.05 |
Diabetic neuropathy |
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06.01.06 |
Diagnostic and monitoring agents for diabetes mellitus |
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Continuous Glucose Monitors (CGM) and consumables
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Formulary
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APC 416-2019 Real time Continuous Glucose Monitoring (rtCGM) for use in pregnant patients with type 1 Diabetes
APC 415-2019 Real time Continuous Glucose Monitoring (rtCGM) for use in children and young people (up to the age of 18) with type 1 Diabetes
APC 414-2019 Real time Continuous Glucose Monitoring (rtCGM) for use in adult patients (≥18 years of age) with type 1 Diabetes
PCN June 2018 - Position statement: Continuous glucose monitoring systems
PCN 335-2018 Continuous Glucose Monitors (CGM) and consumables
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06.01.06 |
Blood glucose monitoring |
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Accu-check Performa Test Strips
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Formulary
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Test strips for use with Performa Nano blood glucose meter.
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Medical Device Alerts issued in April 2018; recent alert about Accu-Chek blood glucose test strips
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Blood Glucose Test Strips & associated meters
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Formulary
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- A preferred list of cost-effective blood glucose meters and the associated test strips have been added onto the formulary. However, there is an exception criteria for certain patients (See excluded group below).
- The selected meters (which meet ISO 15197:2013 requirements) to be included on the preferred list are:
o GlucoMen Areo Sensor o Contour/ Contour Plus (Bayer) o Wavesense Jazz o Wavesense Jazz Duo o Omnitest 3 (Braun) o MyLife Pura o MyLife Unio o GlucoRx Nexus now the preferred speaking meter - suitable for patients with visual impairment
- CareSens Pro Blood Glucose strips added to the formulary to enable the patient to have one meter to test both glucose and ketones (CareSens dual meter)
- Or any meter that meets the above requirements with a test strip cost <£10 for 50
- (Supercheck2 test strips and meter have been discontinued)
- Exclusion group- patients remaining outside the scope of this work are specialist patient groups with specific clinical needs that are not met with the meters on the proposed formulary including:
Patients with gestational diabetes Unstable type 1 diabetic patients who require ketone testing Patients who are carbohydrate counting Patients on insulin pumps Patients with severe manual dexterity problems who cannot use the meters on the preferred list.
- Where a specialist has recommended a meter not on the preferred list, the specialist should communicate to the GP the clinical reasons why the preferred meters are not suitable. In these cases prescribing of other meters should be supported.
- It is recommended that new patients should be started on meters on the preferred list and an informed switch programme should be initiated at routine review of existing patients (who are currently prescribed test strips costing >£10 and where a cost effective formulary meter would be clinically appropriate).
- Meters are not prescribable on the NHS
- Company representative contacts for obtaining meters free of charge are included in the link below (Preferred blood glucose meters and strips)

- Freestyle Optium Blood Glucose test strip - Providing a dual meter (blood glucose and ketones) to patients is sufficient, regardless of if the patient uses the Freestyle Libre system
|
Brighton APC Blood Glucose Meters & Test Strips
Preferred blood glucose meters and strips Crawley CCG, Horsham and Mid-Sussex CCG
|
Flash Glucose Monitoring (FreeStyle Libre)
|
Formulary
|
Approved for prescribing from 1 April 2019 in line with NHS England criteria only.
Commencement must be within diabetes specialist led clinic.
Patients should not be referred specifically for the initiation of flash glucose monitoring. Eligibility is expected to be assessed during routine consultations with specialist as part of the patient's annual diabetes review or a review that takes place as a result of other changes in their diabetic needs.
Indications
- People with Type 1 diabetes
OR with any form of diabetes on hemodialysis and on insulin treatment
who, in either of the above, are clinically indicated as requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past 3 months
OR with diabetes associated with cystic fibrosis on insulin treatment
- Pregnant women with Type 1 Diabetes - 12 months in total inclusive of post-delivery period.
- People with Type 1 diabetes unable to routinely self-monitor blood glucose due to disability who require carers to support glucose monitoring and insulin management.
- People with Type 1 diabetes for whom the specialist diabetes MDT determines have occupational (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick testing) or psychosocial circumstances that warrant a 6-month trial of Libre with appropriate adjunct support.
- Previous self-funders of Flash Glucose Monitors with Type 1 diabetes where those with clinical responsibility for their diabetes care are satisfied that their clinical history suggests that they would have satisfied one or more of these criteria prior to them commencing use of Flash Glucose Monitoring had these criteria been in place prior to April 2019 AND has shown improvement in HbA1c since self-funding.
- For those with Type 1 diabetes and recurrent severe hypoglycemia or impaired awareness of hypoglycemia, NICE suggests that Continuous Glucose Monitoring with an alarm is the standard. Other evidence-based alternatives with NICE guidance or NICE TA support are pump therapy, psychological support, structured education, islet transplantation and whole pancreas transplantation. However, if the person with diabetes and their clinician consider that a Flash Glucose Monitoring system would be more appropriate for the individual’s specific situation, then this can be considered.
Other requirements:
1. Education on Flash Glucose Monitoring has been provided (online or in person)
2. Agree to scan glucose levels no less than 8 times per day and use the sensor >70% of the time.
3. Agree to regular reviews with the local clinical team.
4. Previous attendance, or due consideration given to future attendance, at a Type 1 diabetes structured education programme (DAFNE or equivalent if available locally)
Note: Continuing prescription for long-term use of Flash Glucose Monitoring-post initial 6 months- would be contingent upon evidence of agreeing with the above conditions and that on-going use of the Flash Glucose Monitoring is demonstrably improving an individual’s diabetes self-management- for example improvement of HbA1c or Time In Range; improvement in symptoms such as DKA or hypoglycaemia; or improvement in psycho-social wellbeing.
|
APC 404-2019 (replaces PCN 281 – 2017)Flash Glucose Monitoring System (FGS) for patients (over 4 years of age)
Flash Glucose Monitoring – Frequently Asked Questions for Commissioners
Flash Glucose Monitoring (FGM): Continuation Agreement for Adults
Flash Glucose Monitoring (FGM): Initiation and Transfer Agreement for Adults
Flash Glucose Monitoring (FGM): Initiation and Transfer Agreement for Paediatrics
Flash Glucose Monitoring (FGM): Continuation Agreement for Paediatrics
|
06.01.06 |
Urinalysis |
|
|
Ketones test strips (Ketostix ®)
|
First Choice
|
For detection of ketones in urine
|
|
06.01.06 |
Blood Ketones Testing Strips |
|
|
Blood Ketone Test Strips and associated meters
|
Formulary
|
- A preferred list of cost-effective blood ketone meters and the associated test strips have been added onto the formulary.
- GlucoMen areo Ketone sensors (Menarini)
- KetoSens ketone test strips (Spirit)
Both test strips are £9.95 per 10 strips and have shelf life of 18mths

- Freestyle Optium Ketone Test Strips - providing a dual meter (blood glucose and ketones) to patients is sufficient regardless of if the patient uses the Freestyle Libre system.
- Prescribers are advised that they may continue to prescribe only to paediatric patients who are currently using this product so that the specialist providers at Royal Alexandra Children’s Hospital have time to transition them onto a new product in line with formulary choices.
|
|
06.02 |
Thyroid and Antithyroid drugs |
|
|
06.02.01 |
Thyroid hormones |
|
|
Levothyroxine
|
First Choice
|
Tablets
- NOTE, TEVA 12.5mg strength tablets are significantly more expensive than the other strengths, therefore it is more cost effective to use half of a 25mg strength if needed.
If Lactose-free is required
TEVA brand (Lactose Free) - GP would need to stipulate on the prescription when prescribing that the "patient requires lactose free and TEVA brand to be supplied". This can be done as a pharmacy note on prescription.
|
Teva levothyroxine tablets: re-entry to market and introduction of new tablet strengths - Lactose Free
|
Liothyronine (T3)
|
Formulary
|
Indication-
- Following thyroidectomy where a patient requires liothyronine until radioactive iodine is no longer indicated (PCN 186-2016)
- Treatment of coma of myxoedema (APC 408-2019)
- Severe chronic thyroid deficiency and hypothyroid states occurring in the treatment of thyrotoxicosis (APC 409-2019)
- Treatment of resistant depression (APC 410-2019)
- Liothyronine monotherapy in oncology - thyroid and parathyroid disease (APC 421-2019)
- Liothyronine sodium (monotherapy) - Hypothyroidism in adults with an intolerance to levothyroxine. Please note the Crawley, Horsham and Mid-Sussex CCG decision is RED and differs from the Surrey APC decision of AMBER. (APC 412-2019)
- Liothyronine sodium (combination) - Hypothyroidism in adults with an inadequate response to levothyroxine. Please note the Crawley, Horsham and Mid-Sussex CCG decision is RED and differs from the Surrey APC decision of AMBER. (APC 411-2019)
|
APC 409-2019 (replaces PCN191-2016) Liothyronine (T3) in the management of hypothyroid states occurring in the treatment of thyrotoxicosis.
APC 408-2019 (replaces PCN190-2016) Liothyronine (T3) for the treatment of myxoedema coma
APC 412-2019 (Replaces PCN197-2016 & PCN378-2018) Liothyronine sodium (monotherapy) - Hypothyroidism in adults with an intolerance to levothyroxine
APC 411-2019 (replaces PCN198-2016 & PCN378-2018) Liothyronine sodium (combination) - Hypothyroidism in adults with an inadequate response to levothyroxine
APC 410-2019 (replaces PCN195-2019) Liothyronine (T3) for treatment resistant depression in adults
APC 421-2019 (replaces PCN 379 – 2018) Liothyronine monotherapy in oncology – thyroid and parathyroid disease
|
06.02.02 |
Antithyroid drugs |
|
|
|
Neutropenia and agranulocytosis - Doctors are reminded of the importance of recognising bone marrow suppression induced by carbimazole and the need to stop treatment promptly. Patient should be asked to report symptoms and signs suggestive of infection, especially sore throat. A white blood cell count should be performed if there is any clinical evidence of infection. Carbimazole should be stopped promptly if there is clinical or laboratory evidence of neutropenia. |
|
06.03 |
Corticosteroids |
|
|
|
MHRA Drug Safety Update Aug 2017 - Corticosteroids: rare risk of central serous chorioretinopathy with local as well as systemic administration
Patients on long-term corticosteroid treatment should carry a Steroid Treatment Card which gives guidance on minimising risk and provides details of prescriber, drug, dosage and duration of treatment.
Steroid treatment cards
Steroid treatment cards (see Steroid Treatment Card) should be issued where appropriate, and are available for purchase from:
3M Security Print and Systems Limited Gorse Street, Chadderton Oldham OL9 9QH Tel: 0845 610 1112
GP practices can obtain supplies through their Local Area Team Stores. |
|
|
06.03.01 |
Replacement therapy |
|
|
Fludrocortisone
|
Formulary
|
Tablets
Indications - Mineralocorticoid replacement in adrenocortical insufficiency.
|
|
06.03.02 |
Glucocorticoid therapy |
|
|
|
|
06.03.02 |
Disadvantages of corticosteroids |
|
|
06.03.02 |
Use of corticosteroids |
|
|
06.03.02 |
Pregnancy and breastfeeding |
|
|
06.03.02 |
Administration |
|
|
06.03.02 |
Withdrawal of corticosteroids |
|
|
06.04 |
Sex hormones |
|
|
|
06.04.01 |
Female sex hormones and their modulators |
|
|
06.04.01.01 |
Oestrogens and HRT |
|
|
|
Combined Continuous HRT tablet (Kliovance® )
|
First Choice
|
Tablets
Estradiol with Progestogen
Estradiol/northisterone
Continous Combined therapy - for women with a uterus
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Combined Continuous HRT tablet (Premique®) (Low Dose)
|
First Choice
|
Tablets
Conjugated Oestrogens with Progestogen
Conjugated oestrogens/medroxyprogesterone
Continous Combined therapy - for women with a uterus
Oestrogen derived from equine source
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Combined Cyclical HRT tablet (Elleste-Duet® )
|
First Choice
|
Tablets Estradiol with Progestogen
- 16 x estradiol, 12 x estradiol/northisterone
- Sequential Combined therapy - for women with a uterus
- Courses repeated without interval
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Femoston®
|
First Choice
|
Tablets
Estradiol with Progestogen
For women with a Uterus
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Oestrogens for HRT (Elleste-Solo®)
|
First Choice
|
Tablets
Estradiol only
Estradiol
Unopposed Oestrogen - for women without a uterus
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Combined Continous HRT patch (Evorel Conti® )
|
Second Choice
|
Patches
Estradiol with Progestogen
Estradiol/northisterone
Only prescribe patches for patients with liver impariment or compliance issues
Continuous Combined therapy - for women with a uterus
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Combined Continuous HRT tablet (Kliofem® )
|
Second Choice
|
Tablets
Estradiol with Progestogen
Estradiol/northisterone
Continous Combined therapy - for women with a uterus
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Combined Cyclical HRT patch (Evorel Sequi® )
|
Second Choice
|
Patches
Estradiol with Progestogen
4 x estradiol, 4 x estradiol/northisterone
Only prescribe patches for patients with liver impairment or compliance issues
Sequential Combined therapy - for women with uterus
Courses repeated without interval
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Oestrogen only HRT patch (Evorel®)
|
Second Choice
|
Patches
Estradiol only
Estradiol
Only prescribe patches for patients with liver impairment or compliance issues
Unopposed Oestrogen - for women without a uterus
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Oestrogen only HRT tablet (Premarin®)
|
Second Choice
|
Tablets Conjugated oestrogens
Conjugated Oestrogens only
Conjugated oestrogens
Unopposed Oestrogen - for women without a uterus
Oestrogen derived from equine source
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Oestrogens for HRT (Elleste-Solo® MX)
|
Second Choice
|
Patches
Estradiol only
Women without uterus
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Tibolone (Livial®)
|
Second Choice
|
Tablets
Tibolone has oestrogenic, progestogenic and weak androgenic activity
|
MHRA Drug Safety Update Feb 2009 Tibolone: increased risk of breast cancer recurrence
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
|
06.04.01.01 |
Hormone replacement therapy |
|
|
06.04.01.01 |
Ethinylestradiol |
|
|
Ethinylestradiol
|
Formulary
|
Tablets
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
06.04.01.01 |
Raloxifene |
|
|
Raloxifene Hydrochloride (Evista®)
|
Second Choice
|
Tablets
Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women TA160
Raloxifene for the secondary prevention of osteoporotic fragility fractures in postmenopausal women TA161
Indication - Chemoprevention for women at moderate to high risk of breast cancer

Indication - Osteoporosis - primary prevention.
|
NICE CG164 Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer
NICE TA160 - Updated 2/2018 - Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women
NICE TA161 - Updated 7-2-18 - Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
|
06.04.01.02 |
Progestogens |
|
|
|
Where endometriosis required drug treatment, it may respond to a progestogen adminstered on a continuous basis. Danazol and gonadorelin analogues are also available.
Although oral progestogens have been widely used for menorrhagia they are relatively ineffective compared with tranexamic acid or, particularly where dysmenorrhoea is also a factor mefenamic acid.
Oral progestogens have also been used for severe dysmenorrhoea, but where contraception is also required in younger women the best choice is a combined oral contraceptive.
Progestogens have also been advocated for the alleviation of premenstrual symptoms, but no convincing physiological basis for such treatment has been shown.
Progestogens have been used for the prevention of miscarriage in women with a history of recurrent miscarriage but there is no evidence of benefit and they are not recommended for this purpose. |
|
Medroxyprogesterone Acetate
|
First Choice
|
Tablets
To postpone menstruation (see Overseas Travel Prescribing Guidance)
|
Overseas Travel Prescribing Guidance
|
Norethisterone
|
First Choice
|
Tablets
To postpone menstruation (see Overseas Travel Prescribing Guidance)
|
Overseas Travel Prescribing Guidance
|
Progesterone (Cyclogest®)
|
Formulary
|
Pessaries
|
|
Progesterone (Utrogestan®)
|
Formulary
|
Capsules
|
|
|
|
06.04.02 |
Male sex hormones and antagonists |
|
|
06.04.02 |
Anti-androgens |
|
|
06.04.02 |
Dutasteride and finasteride |
|
|
06.04.03 |
Anabolic steroids |
|
|
|
The protein-building properties of anabolic steroids have not proved benficial in a clinical setting. Their use as body builders or tonics is unjustified. Some athletes may abuse them. |
|
06.05 |
Hypothalamic and pituitary hormones and anti-oestrogens |
|
|
06.05.01 |
Hypothalamic and anterior pituitary hormones and anti-oestrogens |
|
|
|
06.05.01 |
Anti-oestrogens |
|
|
Clomifene Citrate
|
Formulary
|
Tablets
Indication - Fertility treatment - Clomiphene only

There are specialist GPs who prescribe under a commissioned Primary Care Fertility Service. In this case all prescribing and monitoring will be undertaken by the specialist GP from the service.
|
|
06.05.01 |
Anterior pituitary hormones |
|
|
Somatropin ( Omnitrope SurePal®)
|
First Choice
|
Injection Cartridge
- Funded by CCG
- Indications
- Prader Willi Syndrome/Turners Syndrome
- Growth Hormone Deficiency in adults
- Omnitrope and SurePal pen device free from company (Sandoz Ltd). (NOT prescribable on NHS)
- Statement from BSUH Paediatric Endocrinologists‘Omnitrope and Genotropin to be considered as 1st line options in children (with the understanding that other devices are still offered as required to allow patient needs and patient choice to be met).’
|
Growth hormone deficiency (adults) - human growth hormone (TA64)
Human growth hormone (somatropin) for the treatment of growth failure in children (review) (TA188)
Growth Hormone device comparison - Policy Statement PCN 159-2015 - May 2015
APC 2016- Information sheet- Human Growth Hormone in Adults- Aug 2016
APC 2016- Information sheet- Human Growth Hormone in Children- Aug 2016
|
Somatropin (Genotropin ®)
|
First Choice
|
Injection (for use with Genotropin® Pen), Go Quick® Injection, MiniQuick® Injection
Funded by CCG
Indications
Prader Willi Syndrome/Turners Syndrome
Growth Hormone Deficiency in adults
Statement from BSUH Paediatric Endocrinologists‘Omnitrope and Genotropin to be considered as 1st line options in children (with the understanding that other devices are still offered as required to allow patient needs and patient choice to be met).’
|
Growth hormone deficiency (adults) - human growth hormone (TA64)
Human growth hormone (somatropin) for the treatment of growth failure in children (review) (TA188)
Growth Hormone device comparison - Policy Statement PCN 159-2015 - May 2015
APC 2016- Information sheet- Human Growth Hormone in Adults- Aug 2016
APC 2016- Information sheet- Human Growth Hormone in Children- Aug 2016
|
Somatropin (Humatrope®)
|
Formulary
|
Injection
Funded by CCG
Indications
Prader Willi Syndrome/Turners Syndrome
Growth Hormone Deficiency in adults
|
Growth hormone deficiency (adults) - human growth hormone (TA64)
Human growth hormone (somatropin) for the treatment of growth failure in children (review) (TA188)
APC 2016- Information sheet- Human Growth Hormone in Adults- Aug 2016
APC 2016- Information sheet- Human Growth Hormone in Children- Aug 2016
|
Somatropin (Norditropin® SimpleXx )
|
Formulary
|
Injection
Funded by CCG
Indications
Prader Willi Syndrome/Turners Syndrome
Growth Hormone Deficiency in adults
|
Growth hormone deficiency (adults) - human growth hormone (TA64)
Human growth hormone (somatropin) for the treatment of growth failure in children (review) (TA188)
APC 2016- Information sheet- Human Growth Hormone in Adults- Aug 2016
APC 2016- Information sheet- Human Growth Hormone in Children- Aug 2016
|
Somatropin (Saizen® Saizen Click.easy ®)
|
Formulary
|
Injection
Funded by CCG
Indications
Prader Willi Syndrome/Turners Syndrome
Growth Hormone Deficiency in adults
|
Growth hormone deficiency (adults) - human growth hormone (TA64)
Human growth hormone (somatropin) for the treatment of growth failure in children (review) (TA188)
APC 2016- Information sheet- Human Growth Hormone in Adults- Aug 2016
APC 2016- Information sheet- Human Growth Hormone in Children- Aug 2016
|
06.05.01 |
Gonadotrophins |
|
|
06.05.01 |
Growth Hormone |
|
|
06.05.01 |
Growth hormone receptor antagonists |
|
|
06.05.01 |
Thyrotropin |
|
|
06.05.01 |
Hypothalmic hormones |
|
|
06.05.02 |
Posterior pituitary hormones and antagonists |
|
|
|
|
06.05.02 |
Posterior pituitary hormones |
|
|
06.05.02 |
Antidiuretic hormone antagonists |
|
|
06.06 |
Drugs affecting bone metabolism |
|
|
|
|
06.06 |
Osteoporosis |
|
|
06.06.01 |
Calcitonin and parathyroid hormone |
|
|
Teriparatide (Forsteo®)
|
Formulary
|
Injection 250 micrograms/ml
Funded by CCG (women), Funded by NHS England (men)
Indication - Osteoporosis - primary prevention.
for the secondary prevention of osteoporotic fragility in postmenopausal women TA161
|
NICE TA161 - updated 7/2/18 - Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women
PCN Statement 05/2014 - Osteoporosis guideline update
Treatment Guidelines for Osteoporosis in Adults - Nov 17
|
06.06.02 |
Bisphosphonates and other drugs affecting bone metabolism |
|
|
|
|
|
|
|
|
|
06.06.02 |
Bisphosphonates |
|
|
06.06.02 |
Denosumab |
|
|
06.06.02 |
Strontium renelate |
|
|
06.07 |
Other endocrine drugs |
|
|
06.07.01 |
Bromocriptine and other dopaminergic drugs |
|
|
Bromocriptine
|
Formulary
|
Tablets, Capsules
|
MHRA Drug safety update Oct 2008 Ergot-derived dopamine agonists: risk of fibrotic reactions in chronic endocrine uses
Safety review, the European Medicines Agency (EMA) - Bromocriptine
|
Cabergoline
|
Formulary
|
Tablets
|
MHRA Drug safety update Oct 2008 Ergot-derived dopamine agonists: risk of fibrotic reactions in chronic endocrine uses
|
Quinagolide (Norprolac®)
|
Formulary
|
Tablets 75 micrograms, Starter pack
Indication - Hyperprolactinaemia
|
|
06.07.02 |
Drugs affecting gonadotrophins |
|
|
|
|
06.07.02 |
Gonadorelin analogues |
|
|
06.07.02 |
Breast pain (mastalgia) |
|
|
06.07.03 |
Metyrapone |
|
|
06.07.04 |
Somatomedins |
|
|
.... |
Non Formulary Items |
Acarbose (Glucobay®)

|
Non Formulary
|
|
|
Albiglutide (Eperzan®)

|
Non Formulary
|
|
|
Alogliptin / metformin (Vipdomet®)

|
Non Formulary
|
|
|
Alogliptin / pioglitazone (Incresync®)

|
Non Formulary
|
|
|
Bambuterol

|
Non Formulary
|
|
|
Biphasic Isophane Insulin (Hypurin® Porcine 30/70 Mix)

|
Non Formulary
|
|
|
Biphasic Isophane Insulin (Insuman® Comb)

|
Non Formulary
|
Temporary shortage supply of Insulin human - INSUMAN® Comb 25.
No new patients should be started on Insuman® Comb 25(prefilled pens and cartridges) during the shortage and existing patients should be switched to a suitable alternative. (see link below)
Shortage also affects INSUMAN® Basal(prefilled pens and cartridges)
|
EMEA Shortage of Insuman Basal and Comb 25 (insulin human)
Sanofi letter Shortage of Insuman Basal and Comb 25
|
Biphasic Isophane Insulin (Mixtard® 30)

|
Non Formulary
|
|
|
Calcitonin (salmon) / Salcatonin

|
Non Formulary
|
|
|
Calcitonin (salmon) / Salcatonin

|
Non Formulary
|
|
|
Canagliflozin / metformin IR (Vokanamet®)

|
Non Formulary
|
|
MHRA Drug Safety update Mar 2017 SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes)
|
Chlorpropamide

|
Non Formulary
|
|
|
Choriogonadotropin Alfa (Ovitrelle®)

|
Non Formulary
|
|
|
Chorionic Gonadotrophin (Choragon®)

|
Non Formulary
|
|
|
Combination test strips

|
Non Formulary
|
|
|
Combined Cyclical HRT tablet (Prempak-C®)

|
Non Formulary
|
Tablets DISCONTINUED 01/2017 Conjugated Oestrogens with Progestogen
- 28 x conjugated oestrogens, 12 x norgestrel
- Sequential Combined therapy - for women with a uterus
- Courses repeated without interval
- 150 mcg norgestrel ≡ 75 mcg levonorgestrel
- Oestrogen derived from equine source
|
MHRA Press release 02/2015 Hormone replacement therapy (HRT) and the risk of ovarian cancer
|
Conjugated oestrogens and bazedoxifene (Duavive®)

|
Non Formulary
|
0.45 mg/20 mg modified-release tablets
- Treatment of oestrogen deficiency symptoms in postmenopausal women with a uterus (with at least 12 months since the last menses) for whom treatment with progestin-containing therapy is not appropriate.
Patients currently taking Duavive should be reviewed and switched to an alternative preparation.
Product being withdrawn from the market by Dec 2019 |
PCN 428-2019 Duavive (conjugated oestrogens & bazedoxifene) for the treatment of oestrogen deficiency symptoms in postmenopausal women
|
Corifollitropin Alfa (Elonva®)

|
Non Formulary
|
|
|
Dapagliflozin / metformin (Xigduo®)

|
Non Formulary
|
|
|
Diazoxide (Eudemine®)

|
Non Formulary
|
|
|
Dienogest

|
Non Formulary
|
|
|
Dydrogesterone (Duphaston®)

|
Non Formulary
|
|
|
Dydrogesterone (Duphaston® HRT)

|
Non Formulary
|
|
|
Follitropin Alfa (Gonal-F®)

|
Non Formulary
|
|
|
Follitropin Alfa and Beta (Puregon®)

|
Non Formulary
|
|
|
Glibenclamide

|
Non Formulary
|
|
|
Glibenclamide (Daonil®)

|
Non Formulary
|
|
|
Glibenclamide (Euglucon®)

|
Non Formulary
|
|
|
Glibenclamide (Semi-Daonil®)

|
Non Formulary
|
|
|
Gliquidone (Glurenorm®)

|
Non Formulary
|
|
|
Glucose (Clinistix®)

|
Non Formulary
|
|
|
Glucose (Clinitest®)

|
Non Formulary
|
|
|
Glucose (Diabur-Test® 5000)

|
Non Formulary
|
|
|
Glucose (Diastix®)

|
Non Formulary
|
|
|
Glucose test strips

|
Non Formulary
|
|
|
Gonadorelin (HRF®)

|
Non Formulary
|
|
|
Human Menopausal Gonadotrophins (Menogon®)

|
Non Formulary
|
|
|
Human Menopausal Gonadotrophins (Menopur®)

|
Non Formulary
|
|
|
Injection Devices (HumaPen® Ergo)

|
Non Formulary
|
|
|
Injection Devices (mhi-500®)

|
Non Formulary
|
|
|
Injection Devices (NovoPen®3 Demi)

|
Non Formulary
|
For use with Novo Nordisk 3ml cartridges
DISCONTINUED
|
|
Injection Devices (OptiPen Pro 1®)

|
Non Formulary
|
|
|
Injection Devices (SQ-PEN®)

|
Non Formulary
|
|
|
Insulin (Exubera®)

|
Non Formulary
|
|
|
Insulin (Humulin® S)

|
Non Formulary
|
|
|
Insulin (Insuman® Rapid)

|
Non Formulary
|
|
|
Insulin (Pork Actrapid®)

|
Non Formulary
|
|
|
Insulin (Velosulin®)

|
Non Formulary
|
|
|
Insulin bovine (Hypurin® Bovine Neutral)

|
Non Formulary
|
All the latest information about the discontinuation of bovine insulin can be found on the Wockhardt website: http://www.wockhardt.co.uk/our-products/bovine-insulin-patient-information.aspx |
|
Insulin degludec and liraglutide (Xultophy®)

|
Non Formulary
|
Black Triangle |
PCN 183-2016 statement Xultophy (insulin degludec/liraglutide)
MHRA Drug Safety Update 29/04/2015 - High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error
|
Insulin degludec with insulin aspart

|
Non Formulary
|
Approved but not launched in UK |
|
Insulin porcine (Hypurin® Porcine Neutral)

|
Non Formulary
|
|
|
Insulin Zinc suspension (Hypurin®Bovine Lente)

|
Non Formulary
|
All the latest information about the discontinuation of bovine insulin can be found on the Wockhardt website: http://www.wockhardt.co.uk/our-products/bovine-insulin-patient-information.aspx |
|
Isophane Insulin (Hypurin® Bovine Isophane)

|
Non Formulary
|
All the latest information about the discontinuation of bovine insulin can be found on the Wockhardt website: http://www.wockhardt.co.uk/our-products/bovine-insulin-patient-information.aspx |
|
Isophane Insulin (Hypurin® Porcine Isophane)

|
Non Formulary
|
|
|
Isophane Insulin (Pork Insulatard®)

|
Non Formulary
|
|
|
Ketones (Ketur Test®)

|
Non Formulary
|
|
|
Linagliptin/ metformin (Jentadueto®)

|
Non Formulary
|
|
|
Liothyronine (T3) and thyroid extracts

|
Non Formulary
|
Indication-
- Management of ADULTS with hypothyroidism (either alone or in combination with T4 levothyroxine)
The CCGs do not support the use of thyroid extracts (e.g. Armour thyroid, ERFA Thyroid), compounded thyroid hormones, iodine containing preparations, and dietary supplementation are not recommended. The prescribing of unlicensed liothyronine and thyroid extract products are not supported as the safety, quality and efficacy of these products cannot be assured. |
APC 407-2019 (replaces PCN192-2016)t Unlicensed liothyronine and thyroid extract products:
Surrey PAD - Profile : Liothyronine (unlicensed products and thyroid extracts) - Hypothyroidism
PCN 378-2018 Patients currently receiving liothyronine monotherapy, Patients currently receiving liothyronine and levothyroxine combination therapy
NHS England guidance Items which should not routinely be prescribed in primary care
Brighton Joint Formulary Not for routine prescribing (BLACK list)
The Royal College of Physicians -The Diagnosis and Management of Primary Hypothyroidism
|
Liraglutide (Saxenda®)

|
Non Formulary
|
Injection
- Indication - Weight management in adult patients
Primary care prescribers should not accept prescribing responsibility if asked to prescribe by private providers |
MHRA Drug Safety Update Jun 2019 GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued
APC 386-2019 Liraglutide (Saxenda) for weight management
NICE NG28 - May 2017 - Type 2 diabetes in adults: management - replaces TA 203
|
Lixivaptan

|
Non Formulary
|
Indications
Growth Hormone
Growth Hormone Receptor Antagonist |
|
Lucozade®

|
Non Formulary
|
|
|
Lutropin Alfa (Luveris®)

|
Non Formulary
|
|
|
Metformin & pioglitazone (Competact®)

|
Non Formulary
|
|
|
Metformin sachets (Glucophage® SR)

|
Non Formulary
|
PRODUCT DISCONTINUED (both strengths)
Sachets |
|
Oestrogen only HRT implant (Estradiol)

|
Non Formulary
|
|
|
Oestrogens for HRT (Angeliq®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Bedol®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Climagest®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Climaval®)

|
Non Formulary
|
Discontinued 01/2016
|
|
Oestrogens for HRT (Climesse®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Clinorette®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Cyclo-Progynova®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Estracombi®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Estraderm MX®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Estraderm TTS®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Estradiol®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Femapak®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Fematrix®)

|
Non Formulary
|
|
|
Oestrogens for HRT (FemSeven®)

|
Non Formulary
|
|
|
Oestrogens for HRT (FemSeven® Conti)

|
Non Formulary
|
|
|
Oestrogens for HRT (FemSeven® Sequi)

|
Non Formulary
|
|
|
Oestrogens for HRT (FemTab®)

|
Non Formulary
|
|
|
Oestrogens for HRT (FemTab® Sequi)

|
Non Formulary
|
|
|
Oestrogens for HRT (Harmogen®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Hormonin®)

|
Non Formulary
|
Discontinued 01/2016
|
|
Oestrogens for HRT (Indivina®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Menorin® 50)

|
Non Formulary
|
|
|
Oestrogens for HRT (Novofem®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Nuvelle®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Ovestin®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Progynova®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Progynova® TS)

|
Non Formulary
|
|
|
Oestrogens for HRT (Sandrena®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Tridestra®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Trisequens®)

|
Non Formulary
|
|
|
Oestrogens for HRT (Zumenon®)

|
Non Formulary
|
|
|
Oral glucose tolerance test. (Rapilose® OGTT)

|
Non Formulary
|
|
|
Parathyroid Hormone

|
Non Formulary
|
Indication - Osteoporosis |
|
Pegvisomant (Somavert®)

|
Non Formulary
|
Vials for subcutaneous injection
Indication - Acromegaly
Specialist drug. Trusts should apply to the CCG for funding via IFR. |
Brighton Joint Formulary Not for routine prescribing (BLACK list)
|
Pioglitazone and Metfomin (Competact®)

|
Non Formulary
|
|
|
Polycal®

|
Non Formulary
|
|
|
Progesterone (Crinone®)

|
Non Formulary
|
|
|
Progesterone (Gestone®)

|
Non Formulary
|
|
|
Protamine Zinc Insulin (Hypurin® Bovine Protamine Zinc)

|
Non Formulary
|
|
|
Protein (Medi-Test® Protein 2)

|
Non Formulary
|
|
|
Protein test strips (Albustix®)

|
Non Formulary
|
|
|
Protirelin (TRH)

|
Non Formulary
|
|
|
Rosiglitazone (Avandia®)

|
Non Formulary
|
|
|
Rosiglitazone and Metformin (Avandamet®)

|
Non Formulary
|
|
|
Saxagliptin and metformin (Komboglyze®)

|
Non Formulary
|
|
|
Sermorelin (Geref 50®)

|
Non Formulary
|
|
|
Sitagliptin and Metformin (Janumet®)

|
Non Formulary
|
|
|
Tesamorelin

|
Non Formulary
|
Indication - HIV associated Lipodystrophy |
|
Test Strips (Combur 9®)

|
Non Formulary
|
|
|
Test Strips (Combur5® )

|
Non Formulary
|
|
|
Test Strips (Combur7®)

|
Non Formulary
|
|
|
Test Strips (Diastix®)

|
Non Formulary
|
|
|
Test Strips (Keto-Diastix®)

|
Non Formulary
|
|
|
Test Strips (Multistix 10 SG®)

|
Non Formulary
|
|
|
Test Strips (Multistix 8SG®)

|
Non Formulary
|
|
|
Test Strips (Multistix SG®)

|
Non Formulary
|
|
|
Test Strips (Multistix®)

|
Non Formulary
|
|
|
Tetracosactide (Synacthen®)

|
Non Formulary
|
|
|
Thyrotropin Alfa (Thyrogen®)

|
Non Formulary
|
|
|
Tolbutamide

|
Non Formulary
|
|
|
Treatment of hypoglycaemia (Rapilose® gel)

|
Non Formulary
|
|
|
Urinalysis (Clinitest®)

|
Non Formulary
|
|
|
Urofollitropin

|
Non Formulary
|
|
|
|
Key |
|
|
Cytotoxic Drug
|
|
Controlled Drug
|
|
High Cost Medicine
|
|
Cancer Drugs Fund
|
|
NHS England |
|
Homecare |
|
CCG |
|
Traffic Light Status Information
Status |
Description |

|
Comment : Not routinely commissioned in any care setting. This may be due to a lack of good clinical evidence, cost effectiveness, concerns over safety or due to the availability of more suitable alternatives. Deviation from this position may be considered by prescribers on an individual basis, where exceptional circumstances exist. Otherwise, funding via Individual Funding Request (IFR) only.
|

|
Initiation : Specialist or hospital only
Repeat Prescribing : Specialist or hospital only
Monitoring : Specialist or hospital only
Comment : These medicines should be prescribed by clinicians in a hospital setting only for the duration of treatment (primary care prescribing is not appropriate). Prescribing and monitoring should be retained within the hospital setting by an appropriate clinician and the medicines supplied by the hospital for the duration of treatment. In exceptional circumstances a GP may be asked to prescribe/administer but the specialist must provide adequate information and support and retain overall clinical responsibility.
|

|
Initiation : Specialist only
Repeat Prescribing : Any care setting
Monitoring : As defined in Effective Shared Care Agreement (ESCA)
Comment : Monitoring according to Effective Shared Care Agreement (ESCA) for stabilised patients only. GP agreement should be requested by specialist and confirmed/declined by GP on a patient-by-patient basis BEFORE the transfer of prescribing responsibility.
|

|
Initiation and /or Recommendation : Specialist only
Repeat Prescribing : Any care setting
Monitoring : Any care setting
Comment : Suitability as to whether the medicine should be initiated by the specialist or can be recommended by the specialist for Primary care initiation will be clearly documented in each drug monograph on the formulary. If there is a period of stabilisation before transfer of care this will also be stated. Information sheets to support continued Primary care prescribing will be developed if appropriate. The decision will reflect the agreement of the Area Prescribing Committee.
|

|
Initiation : Any care setting
Repeat Prescribing : Any care setting
Monitoring : Any care setting
Comment : Suitable for non-specialist initiation
|

|
Prescribing in approved, specialist tertiary care settings only |

|
Available to buy Over-The-Counter. Patients should be advised to purchase if appropriate. |

|
Non-formulary |
|
|
|