GLP-1 RA & dual GIP/GLP-1 RA (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland
  • GLP-1 RA: glucagon-like peptide-1 receptor agonist
  • GIP: glucose-dependent insulinotropic polypeptide receptor agonist

MHRA advice: GLP-1 receptor agonists: reminder of the potential side effects and to be aware of the potential for misuse (October 2024) (www.gov.uk).

MHRA advice: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued (June 2019) (www.gov.uk).

Refer to protocol for use of GLP-1 analogues.

Medicines for weight management. 

Currently GLP-1 RAs & dual GIP and GLP-1 RAs are NOT recommended to be prescribed in NHS Highland for weight management.

See NHS Highland’s Healthy Weight Pathway and the Pink One for further details (NHS Highland intranet access required). 

Information for patients is here: Medicines for weight management | NHS Highland (scot.nhs.uk)

LIRAGLUTIDE - (First line)

Therapy notes

First line once daily option.

MHRA advice: Ozempic (semaglutide) and Saxenda (liraglutide): vigilance required due to potentially harmful falsified products (November 2023) (www.gov.uk).


Formulation and dosage details

Formulation:

Injection, pre-filled pen 18mg/3mL (Restriction: can be initiated by clinicians who are experienced in the treatment of diabetes, for other circumstances: specialist recommendation only.)

SEMAGLUTIDE - (First line)

Therapy notes

First line once weekly option.

MHRA advice: Ozempic (semaglutide) and Saxenda (liraglutide): vigilance required due to potentially harmful falsified products (November 2023) (www.gov.uk).


Formulation and dosage details

Formulation:

Solution for injection, pre-filled pen (Ozempic) 0·25mg, 0·5mg and 1mg (Restriction: can be initiated by clinicians who are experienced in the treatment of diabetes, for other circumstances: specialist recommendation only.)

Dosage:

As per SMC 2092: : the treatment of adults with insufficiently controlled type 2 diabetes mellitus (T2DM) as an adjunct to diet and exercise:

  • As monotherapy when metformin is considered inappropriate due to intolerance or contraindications
  • In addition to other medicinal products for the treatment of diabetes.

SMC restriction: In addition to other oral anti-diabetic medicines, or as an add-on to basal insulin, as an alternative glucagon-like peptide-1 receptor agonist option. 

Formulation and dosage details

Formulation:

Tablets (Rybelsus) 3mg, 7mg and 14mg (Restriction: can be initiated by clinicians who are experienced in the treatment of diabetes, for other circumstances: specialist recommendation only.)

Dosage:

As per SMC 2287: for the treatment of adults with insufficiently controlled type 2 diabetes mellitus to improve glycaemic control as an adjunct to diet and exercise:

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

SMC restriction: In addition to other oral anti-diabetic medicines, or as an add-on to basal insulin, as an alternative glucagon-like peptide-1 receptor agonist option.

Oral, once daily alternative to subcutaneous semaglutide - when subcutaneous route not suitable.

DULAGLUTIDE - (Second line)

Therapy notes

Second line once weekly option.

Formulation and dosage details

Formulation:

Injection, pre-filled pen 750 micrograms/0·5mL, 1·5mg/0·5mL (Restriction: can be initiated by clinicians who are experienced in the treatment of diabetes, for other circumstances: specialist recommendation only.)

Dosage:

As per SMC 1110/15: in adults with type 2 diabetes mellitus to improve glycaemic control as
add-on therapy in combination with other glucose-lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control. 
SMC restriction: as part of a triple therapy in patients with inadequate glycaemic control on two oral anti-diabetic drugs, as an alternative glucagon-like peptide 1 (GLP-1) agonist option.

TIRZEPATIDE - (Third line)

Therapy notes

Caution. For full details see BNF and Manufacturer information

  • Tirzepatide delays gastric emptying, particularly following the first dose.  This has the potential to slow the rate of absorption of concomitant oral medicines.  The risk of a delayed effect should be considered for oral medicines where a rapid onset of action is important.  Monitor patients on oral medicines with a narrow therapeutic index, especially at the start of tirzepatide treatment and after dose increases.
  • Since reduced efficacy of oral contraceptives cannot be excluded, it is advised that female patients who are overweight or obese and using an oral contraceptive should add a barrier method of contraception or switch to a non-oral contraceptive method for the first 4 weeks of treatment, and for 4 weeks after each dose increase.
  • Discontinue treatment at least one month before planned pregnancy.

Formulation and dosage details

Formulation:

KwikPen 2.5mg, 5mg, 7.5mg, 10mg, 12.5mg, 15mg solution for injection in prefilled pen (Restricted: Specialist recommendation only)

Dosage:

As per SMC2633: for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise and in addition to other oral anti-diabetic medicines as an option when glucagon-like peptide-1 (GLP-1) receptor agonists would be considered.

Place in therapy:

  • Generally after a trial of GLP-1 receptor agonist (RA). This guidance is based on the lack of confirmed CV benefit at present.
  • As an alternative to GLP-1 RAs in the following instances:
    • Supply issue with existing GLP-RAs
    • Suboptimal glycaemia despite GLP-1 RA use
    • High risk individuals in where greater weight loss will have a positive benefit on obesity related complications e.g. young onset, Obstructive Sleep Apnoea etc.

Editorial Information

Last reviewed: 11/02/2021

Approved By: TAM Subgroup

Document Id: F175