This site uses some harmless analytics cookies. We have assumed our visitors have no objections to this but we have provided the facility for you to change your preferences.
More Info
Cookie Information Compliance Cookie Analytics CookiesFunctional Cookies
Cookie Information
This site uses cookies to store information on your device to help us improve the experience of our visitors.

A cookie is usually a small piece of data sent from a website and stored in a user's web browser while a user is browsing a website. When the user browses the same website in the future, the data stored in the cookie can be retrieved by the website to notify the website of the user's previous activity.

To find out more about the cookies this site uses, please see the links to the left.

You can change your mind at any point and update your cookies preferences by clicking on the 'cookies' tab at the top of the page. Note: the selection below applies to this website only.
Compliance Cookie
The compliance cookie remembers the choice that is made here. No personal information is collected about you or about your computer.
Analytics Cookies
The analytics cookies measure the 'hits' on our site. They help us improve user experience by letting us know what information is the most requested, and the routes which the users take through the site. No personal information is collected about you or about your computer.
Functional/Session Cookies
Functional cookies are used for activities such as logging in to a site and completing online forms. They do not contain any personal information and are automatically deleted when you close your browser.
Allow all cookies Allow compliance cookie
This will allow just one cookie to remember your choice to disallow all other cookies.
Disallow all cookies
Cookie Settings
  • Home
  • Pharmacy Services Information
 
  • News & Notices
    • Formulary updates
  • What is the IF?
    • What is the Interface Formulary?
  • Formulary user guide
    • Formulary searching guide
  • Therapeutic Sections
    • 1. Gastro-Intestinal System
      • 1.1 Antacids and alginates
      • 1.2 Antispasmodics and drugs altering gut motility
      • 1.2 Motility stimulants
      • 1.3 Helicobacter pylori eradication
      • 1.3.1 H2 receptor antagonists
      • 1.3.3 Chelates and complexes
      • 1.3.5 Proton pump inhibitors
      • 1.4 Acute diarrhoea
      • 1.5.1 Aminosaylicylates
      • 1.5.2 Corticosteroids
      • 1.5.3 Drugs affecting the immune response
      • 1.6 Laxatives
      • 1.6.6 Peripheral opioid receptor antagonist
      • 1.6.7 Other drugs used in constipation
      • 1.7 Preparations for anal and rectal disorders
      • 1.9 Drugs affecting intestinal secretions
    • 2. Cardiovascular System
      • 2.1 Cardiac glycosides
      • 2.2.1 Thiazide diuretics
      • 2.2.2 Loop diuretics
      • 2.2.3 Potassium sparing diuretics and aldosterone antagonists
      • 2.3 Anti-arrhythmics
      • 2.4 Beta-blocking drugs
      • 2.5 Hypertension and heart failure
      • 2.5.1 Vasodilator antihypertensive drugs
      • 2.5.2 Centrally acting antihypertensive drugs
      • 2.5.4 Alpha blocking drugs
      • 2.5.5 Drugs affecting the renin-angiotensin system
      • 2.5.5.3 Renin inhibitors
      • 2.6.1 Nitrates
      • 2.6.2 Calcium channel blockers
      • 2.6.3 Other antianginal drugs
      • 2.6.4 Peripheral vasodilators
      • 2.7 Sympathomimetics
      • 2.8.1 Parenteral anticoagulants
      • 2.8.2 Oral anticoagulants
      • 2.9 Antiplatelet drugs
      • 2.10.1 Stable angina and acute coronary syndromes
      • 2.10.2 Fibrinolytics
      • 2.11 Antifibrinolytics
      • 2.12 Lipid regulating drugs
    • 3. Respiratory System
      • 3.0 Respiratory system prescribing principles
      • 3.1.1.1 Short-acting adrenoreceptor agonist bronchodilators
      • 3.1.1.1 Long-acting adrenoreceptor agonist bronchodilators
      • 3.1.2 Antimuscarinic bronchodilators
      • 3.1.3 Theophylline
      • 3.1.4 Compound bronchodilator preparations
      • 3.1.5 Peak flow meters and inhaler devices
      • 3.2 Corticosteroids
      • 3.3.2 Leukotriene receptor agonists
      • 3.4.2 Antihistamines
      • 3.4.2 Allergen immunotherapy
      • 3.4.3 Allergic emergencies
      • 3.5 Respiratory stimulants
      • 3.6 Oxygen
      • 3.7 Mucolytics
      • 3.8 Aromatic inhalations
      • 3.9 Cough preparations
      • 3.10 Systemic nasal decongestants
      • 3.11 Antifibrotics
    • 4. Central Nervous System
      • 4.1 Hypnotics and anxiolytics
      • 4.2.1 First generation antipsychotic drugs
      • 4.2.1 Second generation antipsychotic drugs
      • 4.2.2 Antipsychotic depot injections
      • 4.2.3 Antimanic drugs
      • 4.3.1 Tricyclic antidepressants
      • 4.3.3 Selective serotonin reputake inhibitors (SSRIs)
      • 4.3.4 Other antidepressants
      • 4.4 CNS stimulants and drugs used for attention deficit hyperactivity disorder
      • 4.5 Drugs used in the treatment of obesity
      • 4.6 Drugs used in nausea and vertigo
      • 4.7.1 Non-opioid analgesics and compound analgesic preparations
      • 4.7.2 Opioid analgesics
      • 4.7.3 Neuropathic pain
      • 4.7.4 Antimigraine drugs
      • 4.8.1 Antiepileptics
      • 4.8.2 Status epilepticus
      • 4.9.1 Drugs used in parkinsonism and related disorders
      • 4.9.3 Drugs used in essential tremor, chorea, tics and related disorders
      • 4.10.1 Alcohol dependence
      • 4.10.2 Drugs used in nicotine dependence
      • 4.11 Drugs for dementia
    • 5. Infections
      • 5.1.1 Penicillins
      • 5.1.2 Cephalosporins and other beta-lactam antibiotics
      • 5.1.3 Tetracyclines
      • 5.1.4 Aminoglycosides
      • 5.1.5 Macrolides
      • 5.1.6 Clindamycin
      • 5.1.7 Other antibiotics
      • 5.1.8 Sulphonamides and trimethoprim
      • 5.1.9 Antituberculosis drugs
      • 5.1.10 Antileproic drugs
      • 5.1.11 Metronidazole
      • 5.1.12 Quinolones
      • 5.1.13 Nitrofurantoin
      • 5.2 Antifungal drugs
      • 5.3.1 HIV infection
      • 5.3.2 Herpesvirus infections
      • 5.3.2.2 Cytomegalovirus infection
      • 5.3.3 Viral hepatitis
      • 5.3.4 Influenza
      • 5.4.1 Antimalarials
      • 5.4.2 Amobeicides
      • 5.4.8 Drugs for pneumocystis pneumonia
      • 5.5 Anthelmintics
    • 6. Endocrine System
      • 6.1.1 Drugs used in diabetes (Insulins)
      • 6.1.2.1 Antidiabetic drugs - sulfonylureas
      • 6.1.2.2 Biguanides
      • 6.1.2.3 SGLT2 inhibitors
      • 6.1.2.3 DPP-4 inhibitors
      • 6.1.2.3 Incretin mimetics
      • 6.1.2.3 Other diabetic drugs
      • 6.1.4 Treatment of hypoglycaemia
      • 6.1.6 Diagnostic and monitoring devices for diabetes mellitus
      • 6.2 Thyroid and antithyroid drugs
      • 6.3.1 Replacement therapy
      • 6.3.2 Glucocorticoid therapy
      • 6.4.1 Female sex hormones
      • 6.4.1.2 Progestogens and progesterone receptor modulators
      • 6.4.2 Male sex hormones
      • 6.5 Hypothalamic & pituitary hormones and anti-oestrogens
      • 6.6 Drugs affecting bone metabolism
      • 6.7.1 Bromocriptine and other dopaminergic drugs
      • 6.7.2 Drugs affecting gonadotrophins
    • 7. Obstetrics, Gynaecology and Urinary-Tract Disorders
      • 7.1.1 Prostaglandins and oxytocics
      • 7.2.1 Preparations for vaginal atrophy
      • 7.2.2 Vaginal and vulval infections
      • 7.3.1 Combined hormonal contraceptives (Community only)
      • 7.3.2 Progestogen only contraceptives
      • 7.3.3 Spermicidal contraceptives (community only)
      • 7.3.4 Contraceptive devices
      • 7.3.5 Emergency contraception
      • 7.4.1 Drugs for urinary retention
      • 7.4.2 Drugs for urinary frequency, enuresis and incontinence
      • 7.4.3 Drugs used in urological pain
      • 7.4.5 Drugs for erectile dysfunction
    • 8. Malignant Disease and Immunosuppression
      • 8.1 Cytotoxic drugs
      • 8.2.1 Antiproliferative immunosupressants
      • 8.2.2 Corticosteroids and other immunosuppressants
      • 8.2.3 Anti-lymphocyte monoclonal antibodies
      • 8.2.4 Other immunomodulating drugs
      • 8.3.1 Sex hormones in malignant disease - oestrogens
      • 8.3.2 Sex hormones in malignant disease -progestogens
      • 8.3.4.1 Hormone antagonists - breast cancer
      • 8.3.4.2 Gonadorelin analogues and GnRH antagonists
      • 8.3.4.3 Somatostatin analogues
    • 9. Nutrition and Blood
      • 9.1.1 Iron deficiency anaemias
      • 9.1.2 Drugs used in megaloblastic anaemias
      • 9.1.3 Drugs used in hypoplastic, haemolytic and renal anaemias
      • 9.1.4 Drugs used in platelet disorders
      • 9.1.6 Drugs used in neutropenia
      • 9.2.1 Oral preparations for fluid and electrolyte imbalance
      • 9.2.2 Parenteral preparations for fluid and electrolyte imbalance
      • 9.3 Intravenous nutrition
      • 9.4 Oral Nutrition
      • 9.5.1.1 Calcium
      • 9.5.1.2 Hypercalcaemia
      • 9.5.1.3 Magnesium
      • 9.5.2 Phosphorus
      • 9.5.4 Zinc
      • 9.6 Vitamins
      • 9.6.7 Multivitamin preparations
    • 10. Musculoskeletal and Joint Diseases
      • 10.1.1 Non-steroidal anti-inflammatory drugs (NSAIDs)
      • 10.1.2 Corticosteroids
      • 10.1.3 Disease modifying anti-rheumatic drugs (DMARDs)
      • 10.1.4 Drugs used in the treatment of gout
      • 10.2 Drugs used in neuromuscular disorders
      • 10.3 Drugs for the treatment of soft tissue disorders
    • 11. Drugs acting on the eye
      • 11.1 Administration of drugs to the eye
      • 11.2 Control of microbial contamination
      • 11.3 Anti-infective eye preparations
      • 11.4 Corticosteroids and other anti-inflammatory preparations
      • 11.5 Mydriatics and cycloplegics
      • 11.6 Treatment of glaucoma
      • 11.8.1 Tear deficiency and ocular lubricants
      • 11.8.2 Ocular diagnostic & perioperative preparations
    • 12. Ear, Nose, and Oropharynx
      • 12.1.1 Otitis externa
      • 12.1.3 Removal of ear wax
      • 12.2.1 Drugs used in nasal allergy
      • 12.2.2 Topical nasal decongestants
      • 12.2.3 Anti-infective nasal preparations
      • 12.3.1 Drugs for oral ulceration and inflammation
      • 12.3.2 Oropharyngeal anti-infective drugs
      • 12.3.4 Mouthwashes and gargles
      • 12.3.5 Treatment of dry mouth
    • 13. Drugs acting on skin
      • 13.1 Management of skin conditions
      • 13.2 Emollient and barrier preparations
      • 13.3 Topical antipruritics
      • 13.4 Topical corticosteroids
      • 13.5.1 Preparations for eczema
      • 13.5.2 Preparations for psoriasis
      • 13.6 Acne and rosacea
      • 13.7 Preparations for warts and calluses
      • 13.8 Sunscreen preparations
      • 13.10 Anti-infective preparations
      • 13.11 Skin Cleansers
      • 13.12 Antiperspirants
    • 14. Immunological products and vaccines
      • 14.4 Vaccines and antisera
      • 14.5 Immunoglobulins
    • 15. Anaesthetics
      • 15.1.1 Intravenous anaesthetics
      • 15.1.2 Inhalation anaesthetics
      • 15.1.4 Sedative and analgesic peri-operative drugs
      • 15.1.3 Antimuscarinic drugs
      • 15.1.4.4 Other drugs for sedation
      • 15.1.5 Neuromuscular blocking drugs
      • 15.1.6 Drugs for reversal of neuromuscular blockade
      • 15.1.7 Antagonists for central and respiratory depression
      • 15.1.8 Drugs for malignant hyperthermia
      • 15.2 Local anaesthetics
    • Wound management
      • Dressings
      • Wound Management Supplies
  • Prescribing Guidelines
    • Gastro-intestinal guidelines
    • Cardiovascular guidelines
      • Treatment of stable angina/myocardial ischaemia
      • Treatment of acute coronary syndromes
      • Guidelines for prescribing rivaroxaban and dabigatran in AF
      • Heparin and warfarin administration guidance
      • Guidelines for effective management of TIA and Stroke
      • Guidance on the prescribing of aspirin and clopidogrel for cardiology patients
      • Guidance on the prescribing of aspirin, dipyridamole and clopidogrel for occlusive vascular events
      • Optimising the prescribing of lipid lowering agents
      • Guide to achieving target cholesterol reduction
    • Respiratory system guidelines
      • West Kent CCG Management of Chronic Asthma in Adults Costing Guide
      • MTW/West Kent CCG joint COPD guidelines
    • Central nervous system Guidelines
      • Initial treatment of neuropathic pain
      • Opoid analgesics in the management of acute pain
      • Prescribing strong opioids for the management of adult non-cancer chronic pain
    • Miscellaneous guidelines
      • Trust guide to therapeutic drug monitoring
      • Management of strong potassium chloride injection and potassium containing solutions
      • Local smoking cessation advice
      • Rivaroxaban for the treatment of Deep Vein Thrombosis and Pulmonary Embolism
      • Management of patients having surgery whilst on rivaroxaban
      • Management of bleeding for patients on rivaroxaban
      • Diagnosis & treatment of suspected DVT in Primary Care
      • Nil by mouth patients and long term medication
      • Representatives from pharmaceutical companies - information and guidance
      • Unlicensed medicines - policy for the purchase and use of
      • Drugs & Therapeutics Committee - constitution and terms of reference
      • Nicotine replacement therapy
      • Once daily gentamicin
      • Protocol for the use of intravenous paracetamol
      • Therapeutic drug monitoring - a general guide
      • Guidance for the management of complementary & herbal medicines for patients who are nil by mouth
      • Prescribing strong opioids for the management of adult non-cancer chronic pain
      • Alfentanil injection in palliative care
      • CCG Preferred list of Blood Glucose Monitoring Equipment and Needles
      • Dalteparin dosage chart and administration guidance
      • MTW Hospital Ophthalmologist & West Kent Community Opthalmology Team Guideline for Dry Eye Treatment
  • MTW Antimicrobial Guide
    • Introduction & general antimicrobial prescribing guidelines
    • Adult IV to oral antibiotic switch guidelines
    • Antimicrobial stop/review date and indication guidelines
    • Authorisation for pharmacists to make changes to antibiotic prescriptions
    • Restricted antibiotics
    • Respiratory infections
      • Community acquired pneumonia
      • Hospital acquired pneumonia
      • Ventilator associated pneumonia
      • Aspiration pneumonia
      • Post influenza pneumonia
      • Treatment of Pneumocystits Pneumonia (PCP)
      • Other chest and respiratory infections
    • Urinary tract infections
    • Genital tract infections
    • Skin and soft tissue infections
    • Severe sepsis
    • Enteric infections
    • Central nervous system
    • Bacterial endocarditis
    • Helicobacter pylori eradication
    • Intravenous vancomycin - dosing and monitoring in adults
    • Continuous infusion of vancomycin in seriously ill adults
    • Once daily gentamicin dosing in adults
    • Teicoplanin dosing and monitoring in Adults
    • MRSA eradication
    • Splenectomy guidelines
    • Introduction to surgical antibiotic prophylaxis
    • Surgical prophylaxis - Obstetrics and Gynaecology
    • Surgical prophylaxis - Breast
    • Surgical prophylaxis - General and Gastro-intestinal
    • Surgical prophylaxis - Orthopaedic surgery
    • Surgical prophylaxis - Urogenital
    • Surgical prophylaxis - Head and Neck
    • Protocol for the use of Actimel
    • MRSA prophylaxis for invasive radiological procedures
    • Prophylaxis for patients undergoing cardiac procedures
    • MTW Infection Control contacts
    • Neonatal Antibiotic Guidelines
      • Babies on the Neonatal unit
      • Babies admitted to the Children's unit
    • Paediatric Antibiotic Guidelines
    • Malaria Treatment Guidance
    • Antifungal guidelines
      • Adult Antifungal Guidelines
      • Haemato-Oncology Antifungal guidelines
    • Line Lock Therapy for Intra-vascular Line Infection
  • Paediatric guidelines
    • Treatment of allergic rhinitis in children
    • Guideline for the management of allergic rhinitis in children in West Kent (Feb 2009)
    • Oral budesonide for eosinophilic oesophagitis
  • FAQs
    • Adverse drug reaction reporting
    • Alcohol withdrawal
    • Anticoagulants - which are used in the Trust and how are they prescribed?
    • Armour Thyroid
    • Controlled drugs - how do I prescribe?
    • Drug interactions with grapefruit juice
    • Eye drops - how many should be prescribed?
    • Hepatorenal syndrome - recommended treatments
    • Hyperkalaemia - how to manage
    • Hypocalcaemia - how to treat
    • Hypocalcaemia management flow chart
    • Hypomagnesamia - how to treat
    • Hypophosphataemia - how to treat
    • Intravenous Iron - Important Safety Information
    • Isosorbide preparations - guidance for switching
    • Medicine name changes
    • Medicine stability during a heatwave
    • Methylthioninium chloride (Methylene Blue) injection administration
    • Metronidazole and alcohol
    • Modified release preparations - a guide
    • New drugs on the formulary
    • Non-formulary drugs - how to prescribe
    • Prednisolone - enteric coated vs uncoated
    • Privigen (Normal Human Immunoglobulin) administration
    • Rivaroxaban for VTE prophylaxis post elective orthopaedic surgery
    • Splenectomy - vaccines and prophylactic antibiotics
    • Thromboprophylaxis at extremes of body weight
    • Timing of bisphosphonates
    • Tramadol - not first choice?
  • WKCCG Infection Guide
    • Aims & Principles
    • Upper respiratory tract infections
    • Lower respiratory tract infections
    • Meningitis
    • Urinary tract infections
    • Management of recurrent UTI in adults
    • Gastro-intestinal tract infections
    • Genital tract infections
    • Skin and soft tissue infections
    • Eye infections
    • Dental infections
  • WKCCG Dressings List
    • WKCCG & KCHT First Choice Dressings List
  • High Cost Drugs
    • High cost drugs
  • Unlicensed medicines
    • Medicines not classified in the BNF (unlicensed)
  • Shared Care Guidance
    • Treatment of attention deficit hyperactivity disorder (ADHD) in children and young people
    • Dalteparin (Fragmin) for extended treatment and prophylaxis of VTE in patients with solid tumours
    • Melatonin for the treatment of sleep disorders in children and young people
    • Prescribing Denosumab (Prolia)
    • Lithium
    • Dronedarone (Multaq)
    • Riluzole (Rilutek)
    • Mercaptopurine (Puri-Nethol) for Inflammtory Bowel Disease
    • Donepezil, galantamine, rivastigmine and memantine in the treatment of Alzheimer's-type dementia
    • Disease modifying antirheumatic drugs (DMARDs)
    • Sacubitril/valsartan in patients with symptomatic Chronic Heart Failure with reduced ejection fraction
    • Rifaximin for the treatment of hepatic encephalopathy
Therapeutic Sections > 6. Endocrine System






6.1.2.3 Incretin mimetics


It should be remembered that control of modifiable cardiovascular risk factors such as lipids and blood pressure are the most important interventions to be made in patients with type II diabetes.

Specialist use
Liraglutide (Victoza®) Prefilled pen 6mg/ml
xx
Exenatide SR
(Bydureon®)
2mg single dose pens
xx
Exenatide (Byetta®) Prefilled pen 5mcg/dose, 10mcg/dose

Dulaglutide (Trulicity®) Prefilled pen 1.5mg/ml, 3mg/ml


Lixisenatide (Lyxumia®) Prefilled pen 10mcg, 20mcg

National/local guidance

NICE guidance

NG28: Type 2 diabetes in adults - management, December 2015

TA248 Diabetes type 2 - exenatide prolonged release, February 2012.

Spontaneous reports of acute pancreatitis have been received in association with exenatide. If pancreatitis is suspected, exenatide and other potentially suspect medicines should be discontinued. Patients should be informed of the characteristic symptom of acute pancreatitis: persistent, severe abdominal pain; back pain may also be present.
See Drug Safety Update May 2008

GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued. Drug Safety Update June 2019

Prescribing notes

Exenatide, liraglutide and lixisenatide are incretin mimetics. They increase insulin secretion, suppresses glucagon secretion and slow gastric emptying. They are given by subcutaneous injection for treatment of type 2 diabetes.

Exenatide should be considered as part of a triple therapy regimen in carefully selected patients. It may be used in combination with metformin and a sulfonylurea in patients who have not achieved adequate control with these drugs in combination. It is used twice daily and may be given at any time within the 60 minutes period before the two main meals of the day, with doses at least 6 hours apart. It must not be given after meals. Exenatide is also licensed for use with basal insulin, co-prescribing with insulin is not covered in NICE guidance as this was not licensed at the time of publication.

Liraglutide/lixisenatide should be considered as part of a triple therapy regimen in carefully selected patients, also they may occasionally be used in dual therapy regimens if the person is intolerant of either metformin or a sulfonylurea, or treatment with metformin or a sulfonylurea is contraindicated and the person is intolerant of pioglitazone and gliptins, or treatment with pioglitazone and gliptins is contraindicated.

Exenatide prolonged release is a once weekly formulation and is used in carefully selected patients in triple therapy regimes.

Liraglutide should be considered for those patients unable to tolerate exenatide, who only have one main meal a day or with significant needle phobia. It is given once daily irrespective of meal times. Doses above 1.2mg daily should not be used.

Lixisenatide is licensed for use in both dual and triple therapy regimens. It can also be used together with basal insulin. It is not currently included in NICE guidance - it should be prescribed using the same criteria as per NICE guidance for exenatide and liraglutide. Please note: co-prescribing with insulin is not covered in NICE guidance as this was not licensed at the time of publication. It should not be combined with both basal insulin and a sulphonylurea due to increased risk of hypoglycaemia.

Treatment with an incretin mimetic should only be continued if a beneficial metabolic response has been shown (defined as a reduction of at leat 1 percentage point in HbA1c and a weight loss of at least 3% of initial body weight at 6 months).



Hospital Choice Community Choice Specialist Initiation Shared Care Guidance
1st Line 2nd Line Specialist Use Hospital Only Nice Guidance
+ -
Hospital Choice    Community Choice    Specialist Initiation   Shared Care Guidance  
1st Line 2nd Line Specialist Use Hospital Only Nice Guidance




This page was created on 11/02/2014 11:55:48 by Kim Fenner and last modified on 16/07/2019 11:54:15 by Wes (MOM Systems)




Online Formulary Software

Disclaimer & Copyright 404 Not Found
404 Not Found
Please forward this error screen to new.langall.com's WebMaster.

The server can not find the requested page:

  • new.langall.com/new.txt (port 80)
cPanel, Inc.
Copyright © 2016 cPanel, Inc.

BNF

There is no link available to the current electronic BNF website as this is undergoing a complete check due to some accuracy problems.

When using a NHS computer you can access the BNF and BNF for Children at https://www.medicinescomplete.com/mc/.

On this website you will now see four icons for these resources rather than two. Please use BNF Legacy or BNF for Children Legacy as these will take you to the original format of the online publications which do not have any errors or omissions.