NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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6 Endocrine system

6.1 Drugs used in diabetes

6.1.1 Insulins

6.1.1.1 Short-acting insulins

Preferred list
INSULIN LISPRO (HUMALOG)

Prescribing Notes:

Currently, only the 100 units/ml preparations have been considered and added to Formulary. Other strengths are currently non-Formulary

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/39955.htm

INSULIN ASPART

Prescribing Notes:

Insulin aspart preparations may differ in terms of speed of onset of action and should therefore be prescribed by brand name.

Different devices and presentations for administration of the same insulin may differ in cost.  When prescribing for the 1st time, use the most cost-effective device that best meets the patients needs.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/82517.htm

Total Formulary
INSULIN GLULISINE (APIDRA)

Restrictions: Restricted to use in patients where regular human soluble insulin is inappropriate.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129524.htm

6.1.1.2 Intermediate- and long-acting insulins

Preferred list
BIPHASIC INSULIN ASPART (NOVOMIX 30)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106546.htm

BIPHASIC ISOPHANE INSULIN (HUMULIN M3)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4131.htm#_4131

Total Formulary
BIPHASIC INSULIN LISPRO (HUMALOG MIX 50)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/88138.htm

INSULIN DETEMIR (LEVEMIR)

Restrictions: Insulin detemir (LevemirĀ®) is restricted to initiation by consultant diabetologists in children, adolescent and adult patients with severe/ frequent nocturnal hypoglycaemia. Not for routine use in type 2 diabetes unless patients suffers from recurrent episodes of hypoglycaemia.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129026.htm

BIPHASIC INSULIN LISPRO (HUMALOG MIX 25)

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/77951.htm

INSULIN DEGLUDEC

Restrictions: Restricted to use in accordance with local guidance which includes information on preferred alternative options.

Prescribing Notes:

Note: Insulin degludec is available in two strengths and caution should be taken in prescribing, dispensing and administration to ensure the correct strength is received.

INSULIN GLARGINE

Restrictions: Restricted to patients with type 1 diabetes who are at risk of or experience unacceptable frequency and/or severity of nocturnal hypoglycaemia on attempting to achieve better hypoglycaemic control during treatment with established insulins. It is also acceptable as a once daily insulin therapy for patients who require carer administration of their insulin. In patients with type 2 diabetes it should be restricted to those who suffer from recurrent episodes of hypoglycemia or require assistance with their insulin injections.

Prescribing Notes:

It is good practice to prescribe biosimilar insulins by brand name.  

Please note: Insulin glargine is available in two strengths and caution should be taken in prescribing, dispensing and administration to ensure the correct strength is received. 

Insulin glargine 300 units/ml (Toujeo®) is further restricted to use in patients where the use of high-strength insulin is appropriate.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/106539.htm

6.1.2 Antidiabetic drugs

6.1.2.1 Sulfonylureas

Preferred list
Total Formulary
GLIBENCLAMIDE

Prescribing Notes:

Glibenclamide is the sulfonylurea of choice in pregnancy.  Glibenclamide should be avoided in the elderly due to the high incidence of hypoglycaemia.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4168.htm

GLICLAZIDE MR (modified-release tablets)

Restrictions: Restricted to patients who cannot tolerate immediate-release gliclazide or for whom immediate-release preparations are inappropriate

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP4146-gliclazide-non-proprietary.htm#PHP4146-gliclazide-non-proprietary

6.1.2.2 Biguanides

Preferred list
METFORMIN

Restrictions: Metformin SR (Glucophage SRĀ®) is non-Formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4186.htm

6.1.2.3 Thiazolidinediones

Total Formulary
PIOGLITAZONE

Restrictions: Initiation is restricted to clinicians experienced in the treatment of diabetes. Monotherapy is restricted to type 2 diabetes mellitus patients in whom consideration is otherwise being given to commencing insulin therapy. It is not recommended as monotherapy in any other group of patients. Triple therapy (in combination with metformin and a sulphonylurea) in type 2 diabetes is restricted to initiation and monitoring only by physicians experienced in the treatment of diabetes mellitus who will be able to identify and manage patients who might benefit. Use in combination with insulin is restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/88250.htm

PIOGLITAZONE AND METFORMIN

Restrictions: Restricted to initiation by physicians experienced in the treatment of diabetes mellitus for patients who cannot be treated or controlled with a sulphonylurea in combination with metformin.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129900.htm

6.1.2.4 Dipeptidylpeptidase-4 Inhibitors

This class of medicines are not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c. In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate. Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines for further information.

Preferred list
ALOGLIPTIN (tablet)

Prescribing Notes:

  • Alogliptin is the preferred DPP4-inhibitor in NHSGGC
  • This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate
  • Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34577-vipidia.htm#PHP34577-vipidia

LINAGLIPTIN

Restrictions: Restricted to the treatment of type 2 diabetes mellitus as outlined in the prescribing notes section.

Prescribing Notes:

Linagliptin may be a more suitable choice for those patients likely to be subject to increasing renal impairment.

Formulary indications are as follows:

  • as monotherapy in patients for whom both metformin and sulphonylureas are inappropriate due to contradictions or intolerance
  • in combination with metformin when diet and exercise plus metformin alone does not provide adequate glycaemic control in patients for whom the addition of a sulphonylurea is inappropriate. 
  • as combination therapy with a sulphonylurea and metformin when diet and exercise plus dual therapy does not provide adequate glycaemic control
  • in combination with insulin, with or without metformin when this regimen alone, with diet and exercise, does not provide adequate glycaemic control

This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate.

Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/217727.htm

Total Formulary
ALOGLIPTIN AND METFORMIN

Restrictions: It is restricted to use in patients for whom this fixed dose combination of alogliptin and metformin is an appropriate choice of therapy and only when the addition of a sulphonylurea to metformin monotherapy is not appropriate. Combination preparations are further restricted to use only in those patients who have demonstrable compliance issues with the separate constituents.

Prescribing Notes:

This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate

Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP4161-metformin-hydrochloride.htm

LINAGLIPTIN AND METFORMIN (TABLETS)

Restrictions: For restrictions of this combination product please see prescribing notes below.

Prescribing Notes:

For the treatment of type 2 diabetes mellitus

  • in patients for whom a combination of linagliptin and metformin is an appropriate choice of therapy and these fixed-doses are considered appropriate and where there is demonstrable compliance issues with the separate constituents.
  • in combination with insulin (i.e. triple therapy) as an adjunct to diet and exercise when insulin and metformin alone do not provide adequate glycaemic control. It is restricted to use in patients for whom a combination of linagliptin and metformin is an appropriate choice and these fixed-doses are considered appropriate and where there is demonstrable compliance issues with the separate constituents.

This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate

Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP18782-jentadueto.htm?q=LINAGLIptin&t=search&ss=text&p=2#PHP18782-jentadueto

SAXAGLIPTIN

Restrictions: For restrictions please see prescribing notes below

Prescribing Notes:

  • Dual therapy: Use in combination with metformin when a sulphonylurea is contraindicated or not tolerated.
  • Triple therapy: In combination with metformin and a sulphonylurea when this regimen alone, with diet and exercise, does not provide adequate glycaemic control is restricted to use in patients who are inadequately controlled on their respective maximal tolerated doses of metformin and sulphonylurea.
  • The use in combination with insulin (with or without metformin), when this regimen alone, with diet and excercise, does not provide adequate glycaemic control.
  • The use as monotherapy is not recommended by SMC and remains non-Formulary

This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate

Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/203906.htm

SAXAGLIPTIN AND METFORMIN (tablets)

Restrictions: For restrictions please see prescribing notes below

Prescribing Notes:

This combined preparation is Formulary for these restricted indications:

  • Use in patients for whom a combination of saxagliptin and metformin is an appropriate choice of therapy and only when the addition of sulphonylureas to metformin monotherapy is not appropriate. 
  • In combination with a sulphonylurea (i.e. triple combination therapy) as an adjunct to diet and exercise to improve glycaemic control in adult patients with type 2 diabetes mellitus when the maximally tolerated dose of both metformin and the sulphonylurea does not provide adequate glycaemic control.  

In addition this preparation is restricted to those patients who have demonstrated compliance issues with the separate constituents.

This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate

Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP33101-komboglyze.htm?q=saxagliptin&t=search&ss=text&p=4#PHP33101-komboglyze

SITAGLIPTIN

Restrictions:

Formulary indications are summarised in the Prescribing notes below:

Prescribing Notes:

Indications and restrictions for use in type 2 diabetes mellitus:

  • Monotherapy is restricted to patients for whom both metformin and sulphonylureas are inappropriate due to contraindications or intolerance. 
  • Combination with a sulphonylurea is restricted to patients in whom metformin is contraindicated or not tolerated. 
  • Combination with both metformin and a sulphonylurea (i.e triple therapy) is restricted to patients who are inadequately controlled on their respective maximal tolerated doses of metformin and sulphonylurea.
  • Add-on treatment to insulin (with or without metformin).

This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate

Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/130071.htm

SITAGLIPTIN AND METFORMIN

Restrictions: Restricted to use in patients for whom a combination of Sitagliptin and metformin is an appropriate choice of therapy and only when the addition of a sulphonylurea to metformin monotherapy is not appropriate. Combination preparations are further restricted to use only in those patients who have demonstrable compliance issues with the separate constituents.

Prescribing Notes:

This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate

Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/207519.htm

VILDAGLIPTIN

Restrictions: Restricted to the treatment of type 2 diabetes mellitus as outlined in the prescribing notes section

Prescribing Notes:

Formulary indications are as follows:

  • use as monotherapy is restricted to use in patients for whom both metformin and sulphonylureas are inappropriate due to contraindications or intolerance
  • use in combination with metformin or a sulphonylurea for patients with insufficient glycaemic control despite maximum tolerated dose of monotherapy with metformin or a sulphonylurea.
  • use as triple oral therapy in combination with a sulphonylurea and metformin when diet and exercise plus dual therapy with these medicinal products do not provide adequate glycaemic control. It is restricted to use in patients who are inadequately controlled on their respective maximal tolerated doses of metformin and sulphonylurea.

All other licensed indications remain non-Formulary.

This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate

Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201002.htm

VILDAGLIPTIN AND METFORMIN

Restrictions: For restrictions please see prescribing notes below

Prescribing Notes:

Current Formulary indications are:

  • Restricted to use only when the addition of a sulphonylurea is not appropriate for patients with insufficient glycaemic control despite maximum tolerated dose of monotherapy with metformin.
  • Combination preparations are further restricted to use only in those patients who have demonstable compliance issues with the separate constituents.

All other licensed indications remain non-Formulary.

This class of medicines is not considered the most cost-effective choice when used as first-line therapy, and even when used as 2nd or 3rd line, they may only result in a modest reduction of HbA1c.  In some situations, alternative therapy, such as insulin or GLP-1 analogue may be more appropriate

Patients initiated on gliptin therapy should be reviewed at 6 months and treatment should only continue if the patient has had a beneficial metabolic response (a reduction of at least 6mmol/mol in HbA1c).Please see the NHSGGC Diabetes Guidelines (April 2012) for further information (link here).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201549.htm

6.1.2.5 SGLT2 Inhibitors

Total Formulary
CANAGLIFLOZIN (INVOKANA) (tablets)

Restrictions: Restricted to initiation by clinicians experienced in the management of diabetes for the indications outlined below in the Prescribing Notes section:

Prescribing Notes:

Formulary indications for canagliflozin:

use in adults aged 18 years and older with type 2 diabetes mellitus to improve glycaemic control as add-on therapy with other glucose-lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control in the following situations:

  • monotherapy where metformin is contraindicated or not tolerated
  • dual therapy in combination with metformin when a sulphonylurea is inappropriate
  • triple therapy in combination with metformin plus standard of care
  • as an add-on to insulin therapy in combination with insulin plus standard of care. 

Use of canagliflozin as monotherapy is not recommended for use by SMC and remains non-Formulary.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP34485-canagliflozin.htm?q=canagliflozin&t=search&ss=text&p=1#_hit

CANAGLIFLOZIN WITH METFORMIN (VOKANAMET) (tablets)

Restrictions: Restricted to initiation by clinicians experienced in the management of diabetes for the treatment of type 2 diabetes only in adult patients for whom a combination of canagliflozin and metformin is appropriate and who have demonstrated compliance issues with the separate constituents.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34949-vokanamet.htm#PHP34949-vokanamet

DAPAGLIFLOZIN (tablets)

Restrictions: It is restricted to initiation by clinicians experienced in the management of diabetes for the treatment of type 2 diabetes in adult patients for the indications and restrictions detailed in the prescribing notes below.

Prescribing Notes:

  • Monotherapy in adults for whom use of metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control only if a DDP-4 inhibitor would otherwise be prescribed AND a sulphonylurea or pioglitazone is not appropriate
  • Dual therapy in combination with metformin, when metformin alone with diet and exercise does not provide adequate glycaemic control and a sulphonylurea is inappropriate
  • Triple therapy in combination with metformin and sulphonylurea, as an alternative to dipeptidyl peptidase-4 (DPP-4) inhibitor
  • In combination with insulin, when insulin with diet and exercise, does not provide adequate glycaemic control

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP18937-dapagliflozin.htm?q=dapagliflozin&t=search&ss=text&p=1#_hit

DAPAGLIFLOZIN WITH METFORMIN (XIGDUO) (tablets)

Restrictions: Restricted to initiation by clinicians experienced in the management of diabetes for the treatment of type 2 diabetes only in adult patients for whom a combination of dapagliflozin and metformin is appropriate and who have demonstrated compliance issues with the separate constituents.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP34523-xigduo.htm?q=dapagliflozin&t=search&ss=text&p=2#PHP34523-xigduo

EMPAGLIFLOZIN

Restrictions: Use is restricted to initiation by clinicians experienced in the management of diabetes for the treatment of type 2 diabetes in accordance with the prescribing notes below:

Prescribing Notes:

It is restricted to initiation in adult patients:

  • As monotherapy in adults for whom use of metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control and only if a DDP-4 inhibitor would otherwise be prescribed and a sulphonylurea or pioglitazone is not appropriate
  • As dual therapy in combination with metformin, when a sulphonylurea is inappropriate
  • As triple therapy in combination with metformin plus standard of care or as add-on to insulin therapy in combination with insulin plus standard of care.

EMPAGLIFLOZIN WITH METFORMIN (SYNJARDY) (tablets)

Restrictions: Restricted to initiation by clinicians experienced in the management of diabetes for use in patients with type 2 diabetes mellitus for whom this fixed dose combination is considered appropriate or for use as duel therapy when a sulfonylurea is inappropriate. Additionally, it is restricted to patients who have demonstrated compliance issues with the separate constituents.

6.1.2.6 GLP-1 agonists

Total Formulary
ALBIGLUTIDE (EPERZAN) (injection)

Restrictions: Restricted to initiation by clinicians experienced in the treatment of diabetes as an alternative once weekly glucagon-like peptide-1 (GLP-1) agonist for use in combination with oral anti-diabetic agents as a third-line pre-insulin treatment option.

DULAGLUTIDE (TRULICITY) (injection)

Restrictions: Restricted to initiation by clinicians experienced in the management of diabetes 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.

EXENATIDE (injection)

Restrictions: Restricted to initiation by clinicians experienced in the management of diabetes in accordance with the prescribing notes below.

Prescribing Notes:

Once-weekly preparation:

  • The once-weekly preparation is restricted to third line treatment of type-2 diabetes mellitus in combination with other agents.

Twice daily preparation:

  • The twice daily preparation is restricted to use as an alternative for patients who have failed treatment on metformin and/or sulphonylureas and in whom insulin would be the next treatment option. 
  • Use in combination with metformin and a thiazolidinedione is restricted to use as a third-line pre-insulin treatment option.
  • Adjunctive therapy to basal insulin with or without metformin and/or pioglitazone in adults with type 2 diabetes who have not achieved adequate glycaemic control with these agents..

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/130082.htm

INSULIN DEGLUDEC WITH LIRAGLUTIDE (XULTOPHY) (injection)

Restrictions: Restricted to initiation by Consultant Diabetologists for use in patients who are uncontrolled on basal insulin analogues (glycosylated haemoglobin [HbA1c] >7.5% [59mmol/mol]) and for whom a GLP-1 receptor agonist is appropriate as an add-on intensification therapy to basal insulin to obtain glucose control.

Prescribing Notes:

Single agent insulin degludec is not recommended for use in NHSScotland and is not included in the GGC Formulary.

BNF Link: https://www.medicinescomplete.com/mc/bnf/current/PHP101222-insulin-degludec-with-liraglutide.htm?q=insulin%20deglutec&t=search&ss=text&p=1#_hit

LIRAGLUTIDE (injection)

Restrictions: Restricted to initiation by clinicians experienced in the management of diabetes. For Formulary indications and applicable restrictions, see prescribing notes below.

Prescribing Notes:

Liraglutide is included in the Formulary, subject to restrictions, for the following indications:

  • as a third-line antidiabetic agent in combination with metformin and a sulphonylurea or metformin and a thiazolidinedione
  • in combination with basal insulin, with or without metformin. when this regimen alone, with diet and exercise, does not provide adequate glycaemic control.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/203878.htm

LIXISENATIDE (LYXUMIA) (injection)

Restrictions: The treatment of adults with type 2 diabetes mellitus to achieve glycaemic control in combination with oral glucose-lowering medicinal products and/or basal insulin when these, together with diet and exercise, do not provide adequate glycaemic control is restricted to initiation by clinicians experienced in the management of diabetes as a third-line agent, either in combination with metformin and a sulphonylurea or metformin and a thiazolidinedione, or as adjunctive therapy to basal insulin in patients for whom a glucagon-like protein 1 (GLP-1) agonist is appropriate.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP33516-lixisenatide.htm?q=lixisenatide&t=search&ss=text&p=1#_hit

6.1.2.7 Other Antidiabetic Drugs

Total Formulary
ACARBOSE

Restrictions: Restricted to specialist initiation. Restricted to clinicians experienced in treating diabetes. Acarbose is restricted to use in patients refractory or intolerant to treatment with metformin.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4190.htm

6.1.3 Diabetic ketoacidosis

6.1.4 Treatment of hypoglycaemia

Preferred list
GLUCAGON (GLUCAGEN HYPOKIT)

Prescribing Notes:

Used on the treatment of hypoglycaemia (often when patient is unconscious) when oral glucose is not possible.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4196.htm