A variety of combinations tablets (dual therapies) of oral diabetes medication can be prescribed and are available in the Drug Tariff.   

Overall, they may improve compliance in patients, however some combinations would then not allow the flexibility in dosing that is required for diabetes management and in some cases increase the tablet burden. There are specific sick-day rules related to stopping certain medication which would be further complicated where they are not prescribed in their separate formulations.

Furthermore, for the overall health economy not all combination therapies are cost-effective and this will be increasingly so as the patents expire over the near future.

There are some combination therapies that are not recommended in the oral guidance and clinicians are guided to review and discuss these with patients as part of shared -care decision making. 

There are complexities also around the lack of licensing of dual therapies in specific cohorts of patients, related to prescribing for the indication of heart failure or renal disease, making this a complex area for prescribing in primary care. 

A variety of combinations tablets (dual therapies)
of oral diabetes medication can be prescribed and
are available in the Drug Tariff.

Overall, they may improve compliance in patients,
however some combinations would then not allow
the flexibility in dosing that is required for diabetes
management and in some cases increase the
tablet burden. There are specific sick-day rules
related to stopping certain medication which
would be further complicated where they are not
prescribed in their separate formulations.

Furthermore, for the overall health economy not
all combination therapies are cost-effective and
this will be increasingly so as the patents expire
over the near future. There are some combination
therapies that are not recommended in the oral
guidance and clinicians are guided to review and
discuss these with patients as part of shared -care
decision making.

There are complexities also around the lack of
licensing of dual therapies in specific cohorts of
patients, related to prescribing for the indication of
heart failure or renal disease, making this a
complex area for prescribing in primary care

A variety of combinations tablets (dual therapies)
of oral diabetes medication can be prescribed and
are available in the Drug Tariff.

Overall, they may improve compliance in patients,
however some combinations would then not allow
the flexibility in dosing that is required for diabetes
management and in some cases increase the
tablet burden. There are specific sick-day rules
related to stopping certain medication which
would be further complicated where they are not
prescribed in their separate formulations.

Furthermore, for the overall health economy not
all combination therapies are cost-effective and
this will be increasingly so as the patents expire
over the near future. There are some combination
therapies that are not recommended in the oral
guidance and clinicians are guided to review and
discuss these with patients as part of shared -care
decision making.

There are complexities also around the lack of
licensing of dual therapies in specific cohorts of
patients, related to prescribing for the indication of
heart failure or renal disease, making this a
complex area for prescribing in primary care

In line with NICE No significant clinical benefit when used in combination with Insulin – avoid using together 

In line with NICE
Linagliptin has no significant clinical benefit or renoprotective effect in patients with CKD.

Sitagliptin should be used first line at the appropriate renal dose
where a DPP4 inhibitor is indicated

No significant clinical benefit when used in combination
with Insulin – avoid using together

PLEASE PRESCRIBE BY BRAND - NICE Guidance on prescribing

•  prolonged-release suspension for injection

PLEASE PRESCRIBE BY BRAND - NICE Guidance on prescribing

• Injection
• For weight loss/ obesity
• Use according to NICE guidance

The use of Liraglutide for this indication is restricted to prescribing in secondary care by a specialist multidisciplinary Tier 3 weight management service with a commercial agreement in place.

Prescribe by brand (Saxenda ^®) to avoid patients inadvertently receiving a different product licensed for type 2 diabetes

PLEASE PRESCRIBE BY BRAND - NICE Guidance on prescribing

Use according to NICE guidance

For the treatment of type 2 diabetes ONLY

THIS IS FOR DIABETES ONLY.  Prescribe by brand (Victoza^®) to avoid patients inadvertently receiving a different product licensed for obesity.

PLEASE PRESCRIBE BY BRAND - NICE Guidance on prescribing

Rybelsus is a tablet for once-daily oral use but has special administration directions:

• It must be taken on an empty stomach at any time of the day.

• Patients are required to wait at least 30 minutes before eating/drinking or taking other oral medicinal products. Waiting less than 30 minutes decreases absorption.

• It should be swallowed whole with a sip of water (up to half a glass of water equivalent to 120 ml).

PLEASE PRESCRIBE BY BRAND - NICE Guidance on prescribing

Semaglutide is a biological medicine. Biological medicines must be prescribed and dispensed by brand name, see Biological medicines and Biosimilar medicines, under Guidance on Prescribing; manufacturer advises to record the brand name and batch number after each administration.

• Injection
• For weight loss/ obesity
• Use according to NICE TA 875 https://www.nice.org.uk/guidance/ta875/resources/semaglutide-for-managing-overweight-and-obesity-pdf-82613674831813

The use of semaglutide for this indication is restricted to prescribing by commissioned clinics in secondary care by a consultant led specialist multidisciplinary Tier 3 weight management service with a commercial agreement in place.

Prescribe by brand (Wegovy^®) to avoid patients inadvertently receiving a different product licensed for type 2 diabetes.

For treating Type 2 diabetes  in line with NICE, and chronic kidney disease.

Do not use SGLT2-inhibitors in patients with T1DM, regardless of CKD and/or heart failure status due to risk of DKA (diabetic ketoacidosis) 

  for treating Type 2 diabetes and chronic kidney disease in line with NICE 

Do not use SGLT2-inhibitors in patients with T1DM, regardless of CKD and/or heart failure status due to risk of DKA (diabetic ketoacidosis)

 Treatment of all grades of symptomatic heart failure 

SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis

MHRA: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes)

  For treating type 2 diabetes
Do not use SGLT2-inhibitors in patients with T1DM, regardless of CKD and/or heart failure status due to risk of DKA (diabetic ketoacidosis)

 treatment of all grades of symptomatic heart failure

SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis

MHRA: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes)

In line with NICE

Do not use SGLT2-inhibitors in patients with T1DM,
regardless of CKD and/or heart failure status due to risk
of DKA (diabetic ketoacidosis)

• Axsain
• Zacin

• Qutenza - PAIN TEAM ONLY

Prescribe generically as 30mg & 60mg.

90 and 120mg not cost-effective