Acute pancreatitis associated with gliptins has been reported. Inform patients of the symptoms of acute pancreatitis. If pancreatitis is suspected, the DPP-4 inhibitor should be discontinued.
• Only continue DPP-4 inhibitor therapy if the person has had a beneficial metabolic response (a reduction of at least 0.5 percentage points in HbA1c in 6 months) –as per NICE CG87.
• Monotherapy: Saxagliptin, Sitagliptin and Linagliptin – only if metformin contra-indicated or not tolerated. Alogliptin is not licensed for monotherapy. • See individual SPCs for details of dosage in renal impairment.
Nateglinide only licensed for use in combination with metformin. Cautioned in moderate hepatic impairment.
Repaglinide can be given as monotherapy or in combination with metformin. It should be avoided in patients >75 years old and in patients with severe liver disease.
Non Formulary Items
Linagliptin/ metformin (Jentadueto®)
Pioglitazone and Metfomin (Competact®)
Rosiglitazone and Metformin (Avandamet®)
Saxagliptin and metformin (Komboglyze®)
Sitagliptin and Metformin (Janumet®)
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Drugs designated amber are suitable for shared care arrangements under a shared care protocol.
Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.
These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.
Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.
Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.
Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.
Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.
Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.