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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 6 - Endocrine system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
06.01.02.03 Other antidiabetic drugs
DSU February 2019 SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) DSU: GLP-1 receptor agonists: reminder of the potential side effects and to be aware of the potential for misuse GLP-1 and dual GIP/GLP-1 receptor agonists: potential risk of pulmonary aspiration during general anaesthesia or deep sedation - GOV.UK MHRA Drug Safety Update: SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness (March 2020)
06.01.02.03 DPP-4 inhibitors
06.01.02.03 GLP-1 mimetics
DSU February 2019 SGLT2 inhibitors: reports of Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) DSU: GLP-1 receptor agonists: reminder of the potential side effects and to be aware of the potential for misuse GLP-1 and dual GIP/GLP-1 receptor agonists: potential risk of pulmonary aspiration during general anaesthesia or deep sedation - GOV.UK MHRA Drug Safety Update: SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness (March 2020)

Dulaglutide 0.75mg, 1.5mg (Trulicity®)
(Pre-filled pen or syringe)

GREEN
Formulary

For initiation by General Practice Diabetes Specialist or healthcare professional (HCP) in GP Practice with relevant expertise and experience in management of  type 2 diabetes(T2DM).

 Amber SPIS For children under 18

See prescribing guidance below.

Entry Reviewed: March 2025

BNF BNFc SPC
Guidance for General Practitioners to support prescribing of Dulaglutide (Trulicity®) for children and young people under 18 years with Type 2 Diabetes (T2DM) – BLMKICB Medicines Optimisation MHRA DSU June 2019: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

Liraglutide

 
Formulary

Green 6mg/1mL Injection

For initiation by General Practice Diabetes Specialist or healthcare professional (HCP) in GP Practice with relevant expertise and experience in management of  type 2 diabetes(T2DM).

_______________________________________________________________

 Amber SPIS For paediatric use in Type 2 diabetes from age 10 (licensed) - see supporting guidance for GPs

 

The most cost effective biosimilar is Zegluxen®.

NB Victoza® brand has been discontinued.

 

Entry Reviewed: March 2025

BNF BNFc SPC
Guidance for General Practitioners to support prescribing of Liraglutide for children and young people under 18 years with Type 2 Diabetes (T2DM) – BLMKICB Medicines Optimisation MHRA DSU June 2019: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued Type 2 diabetes in adults: management (NG28) (Dec 15)

Lixisenatide

GREEN
Formulary

No prescribing for new patients following JPC June 2019

Restricted Item No new initiations, existing patients may remain on lixisenatide

 
50microgram/1mL Pre-filled Pen
100microgram/1mL Pre-filled Pen

Entry reviewed: March 2025

BNF BNFc SPC
MHRA DSU June 2019: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

Semaglutide 0.25mg, 0.5mg, 1mg (Ozempic®)
(pre-filled pen)

GREEN
Formulary

For initiation by General Practice Diabetes Specialist or healthcare professional (HCP) in GP Practice with relevant expertise and experience in management of  type 2 diabetes(T2DM).

 How to recycle pens using PenCycle®

See prescribing guidance below

Entry Reviewed: March 2025

BNF BNFc SPC
MHRA DSU June 2019: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued MHRA DSU Nov 2023 Ozempic▼(semaglutide) and Saxenda (liraglutide): vigilance required due to potentially harmful falsified products

Semaglutide Oral Tablets (Rybelsus®)

GREEN
Formulary

For initiation by General Practice Diabetes Specialist or healthcare professional (HCP) in GP Practice with relevant expertise and experience in management of  type 2 diabetes(T2DM).

See also prescribing guidance link below

Oral Semaglutide (Rybelsus®)

  • Prescribe by brand
  • Counsel patients on specific dosing requirements:  Take on an empty stomach at any time of the day, swallow whole with a sip of water (up to half a glass of water equivalent to 120 ml) and wait at least 30mins before eating or drinking or taking other oral medicines (NB: intake with food or large volumes of water decreases the absorption of semaglutide).
  • If switching between oral and s/c semaglutide, note the effect cannot easily be predicted because of the high pharmacokinetic variability of oral semaglutide. Clinical effectiveness should be considered when making switching decisions between formulations ( NB: an oral dose of semaglutide 14 mg once daily is comparable to s/c semaglutide 0.5 mg once weekly).
  • Caution if patients are being treated with semaglutide at same time as with levothyroxine, monitoring of thyroid parameters should be considered.

 

 

Initial formulation

(one oval tablet)

 Bioequivalent New formulation (one round tablet)
3mg (starting dose) = 1.5mg (starting dose)
7mg (maintenance dose) = 4mg (maintenance dose)
14mg (maintenance dose) = 9mg (maintenance dose)

Entry reviewed: September 2025

BNF BNFc SPC
MHRA DSU GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

Tirzepatide solution for injection in pre-filled pen (Mounjaro®)
(Type 2 diabetes)

GREEN
Restricted Drug Restricted

For use in accordance with the NICE TA below only.

2.4ml pre-filled pens (1 pen/4 doses): 2.5mg/0.6ml, 5mg/0.6ml, 7.5mg/0.6ml, 10mg/0.6ml, 12.5mg/0.6ml and 15mg/0.6ml KwikPens

Note: use for the management of overweight and obesity is Red.  See section 04.05 for more information.

Entry reviewed: February 2025

BNF BNFc SPC
BLMK ICB: Tirzepatide (Mounjaro®) for Treating Type 2 Diabetes (T2DM) in Adults NICE TA924: Tirzepatide for treating type 2 diabetes
06.01.02.03 SGLT2 inhibitors
06.01.02.03 Other
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.