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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
06.01.02.03 SGLT2 inhibitors
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)

Dapagliflozin
(For patients with Type 2 diabetes)

GREEN
First Choice

Prescribe generically

  • If patient is already on insulin : discuss with Community Diabetes Specialist teams before initiation of SGLT2i
  • Seek advice and guidance from specialist teams for patients on sulphonylurea/or those predisposed to hypoglycaemic events
  • Counsel all patients starting SGLT2 about risk of DKA
  • Click link for DKA patient information leaflet

Approved for use in patients with T2DM and established heart failure / CVD in line with NICE NG28.

Approved for use in patients with T2DM and CKD in line with NICE NG28.

 Approved in accordance with the below NICE TA(s).

 

Entry reviewed: September 2025

BNF BNFc SPC
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 TA775: Dapagliflozin for chronic kidney disease

Canagliflozin
(For patients with Type 2 diabetes)

GREEN
Formulary
  • If patient is already on insulin : discuss with Community Diabetes Specialist teams before initiation of SGLT2i
  • Seek advice and guidance from specialist teams for patients on sulphonylurea/or those predisposed to hypoglycaemic events
  • Counsel all patients starting SGLT2 about risk of DKA
  • Click link for DKA patient information leaflet

Approved for use in patients with T2DM and established heart failure / CVD in line with NICE NG28.

Approved for use in patients with T2DM and CKD in line with NICE NG28.

 Approved in accordance with the following NICE TA(s):-

BNF BNFc SPC
NICE TA315: Canagliflozin in combination therapy for treating type 2 diabetes NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes MHRA Drug Safety Update (June 2016) - Canagliflozin (Invokana▼, Vokanamet▼): signal of increased risk of lower extremity amputations observed in trial in high cardiovascular risk patients

Empagliflozin
(For patients with Type 2 diabetes)

GREEN
Formulary
  • If patient is already on insulin : discuss with Community Diabetes Specialist teams before initiation of SGLT2i
  • Seek advice and guidance from specialist teams for patients on sulphonylurea/or those predisposed to hypoglycaemic events
  • Counsel all patients starting SGLT2 about risk of DKA
  • Click link for DKA patient information leaflet

Amber SPIS For children under 18

Approved for use in patients with T2DM and established heart failure / CVD in line with NICE NG28.

 Approved in accordance with the following NICE TA(s):-

BNF BNFc SPC
BLMK ICB Guidance for General Practitioners to support prescribing of Empagliflozin (Jardiance®) for children and young people under 18 years with Type 2 Diabetes (T2DM) NICE TA336 : Empagliflozin in combination therapy for treating type 2 diabetes NICE TA390: Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes NICE TA1006: Empagliflozin for treating type 2 diabetes in people 10 to 17 years (terminated appraisal)

Ertugliflozin (Steglatro®)
(For patients with Type 2 diabetes)

GREEN
Formulary
  • If patient is already on insulin : discuss with Community Diabetes Specialist teams before initiation of SGLT2i
  • Seek advice and guidance from specialist teams for patients on sulphonylurea/or those predisposed to hypoglycaemic events
  • Counsel all patients starting SGLT2 about risk of DKA
  • Click link for DKA patient information leaflet

As per NICE NG28, cardiovascular outcome data for ertugliflozin is not comparable to that for empagliflozin, dapagliflozin and canagliflozin which all have proven evidence of reducing CV events/mortality in patients with type 2 diabetes.

Approved in accordance with the following NICE TA(s):-

BNF BNFc SPC
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
Non formulary items

Dapagliflozin (For Type 1 diabetes)

DNP
Non Formulary

As of November 2021: Dapagliflozin is no longer licensed for treating Type 1 diabetes (NICE TA 597 retired). No new patient initiations for T1DM unless under exceptional circumstances and agreed on a case per case basis in line with the Trust's unlicensed medicines policy. Continued use in existing patients where they have shown benefit from dapagliflozin for T1DM would be an off-label use of the medicine (SpA for such existing patients).

BNF BNFc SPC
Removal of Type 1 indication for dapagliflozin (DSU Dec 2021)
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.