6.1.2.6. 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 an incretin mimetic may be more appropriate. Stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Diabetes Guidelines for further information.
Restrictions:
Formulary indications are summarised in the Prescribing notes below:
Prescribing Notes:
Indications and restrictions for use in type 2 diabetes mellitus:
- Sitagliptin is the preferred DPP4-inhibitor in NHSGGC.
- Monotherapy is restricted to patients for whom both metformin and sulfonylureas are inappropriate due to contraindications or intolerance.
- Combination with a sulfonylurea is restricted to patients in whom metformin is contraindicated or not tolerated.
- Combination with both metformin and a sulfonylurea (i.e. triple therapy) is restricted to patients who are inadequately controlled on their respective maximal tolerated doses of metformin and sulfonylurea.
- 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 stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Diabetes Guidelines for further information (link here).
Restrictions:
Restricted to the treatment of type 2 diabetes mellitus as outlined in the prescribing notes section.
Prescribing Notes:
Linagliptin is the DPP4 inhibitor of choice where eGFR is <45ml/min or patients have a rapidly declining renal function.
Formulary indications are as follows:
- as monotherapy in patients for whom both metformin and sulfonylureas 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 sulfonylurea is inappropriate.
- as combination therapy with a sulfonylurea 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 stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Diabetes Guidelines for further information (link here).
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 stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Type 2 Diabetes Guideline for further information (link here).
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 sulfonylurea 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 stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Type 2 Diabetes Guidelines for further information (link here).
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 stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Diabetes Guidelines for further information (link here).
Restrictions:
For restrictions please see prescribing notes below
Prescribing Notes:
- Dual therapy: Use in combination with metformin when a sulfonylurea is contraindicated or not tolerated.
- Triple therapy: In combination with metformin and a sulfonylurea 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 sulfonylurea.
- The use in combination with insulin (with or without metformin), when this regimen alone, with diet and exercise, 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 stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Diabetes Guidelines for further information (link here).
Restrictions:
Restricted to the treatment of type 2 diabetes in adults in combination with metformin when the use of a sulfonylurea is inappropriate.
Combination preparations are further restricted to use only in those patients who have demonstrable compliance issues with the separate constituents
Prescribing Notes:
NHSGGC Diabetes Guidelines click here
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 sulfonylurea 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 stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Diabetes Guidelines for further information (link here).
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 sulfonylureas are inappropriate due to contraindications or intolerance
- use in combination with metformin or a sulfonylurea for patients with insufficient glycaemic control despite maximum tolerated dose of monotherapy with metformin or a sulfonylurea.
- use as triple oral therapy in combination with a sulfonylurea 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 stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Diabetes Guidelines for further information (link here).
Restrictions:
For restrictions please see prescribing notes below
Prescribing Notes:
Current Formulary indications are:
- Restricted to use only when the addition of a sulfonylurea 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 demonstrable 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 stop medication if individualised target not achieved AND HbA1c falls less than 0.5% (5.5mmol/mol). Please see the NHSGGC Diabetes Guidelines for further information (link here).