netFormulary

Dulaglutide Trulicity^®

Formulary

Pre-filled pen 0.75mg/0.5mL, 1.5mg/0.5mL

First line GLP-1 agonist

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

Liraglutide

Formulary

Injection 6mg/mL pre-filled pen

Second line GLP-1 agonist, if daily administration preferred.

Ensure the correct liraglutide product is supplied. Prescribe by brand in accordance with the licensed indications for each product.

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

Liraglutide�

Formulary

Managing overweight and obesity.

Ensure the correct liraglutide product is supplied. Prescribe by brand in accordance with the licensed indications for each product.

MHRA: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

MHRA: Ozempic▼(semaglutide) and Saxenda (liraglutide): vigilance required due to potentially harmful falsified products

NICE TA664: Liraglutide for managing overweight and obesity

Semaglutide Ozempic^®

Formulary

Solution for injection - pre-filled pen 0.25mg, 0.5mg, 1mg

First line GLP-1 agonist.

Prescribe by brand.

MHRA: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

MHRA: Ozempic▼(semaglutide) and Saxenda (liraglutide): vigilance required due to potentially harmful falsified products

Semaglutide Rybelsus^®

Formulary

First line GLP-1 agonist.

Alternative GLP-1 receptor agonist for patients who are unable to use subcutaneous formulations or patients who prefer oral administration.

THIS PAGE WAS UPDATED 30.10.25 – PLEASE NOTE THE INFORMATION BELOW

Rybelsus tablets will be replaced with a new formulation with increased bioavailability, which is

bioequivalent to the initial formulation as described below:

PLEASE DO NOT ATTEMPT TO CHANGE OVER YOUR PATIENTS TO THE NEW STRENGTHS CURRENTLY.

AWAIT FURTHER DIRECTIONS.

The new formulation has the same efficacy, safety and method of administration as the initial formulation.

Rybelsus should always be used as one tablet per day.
The two formulations will temporarily co-exist on the market, which may cause mix-ups. This could result in overdosing, which increases the risk of adverse events.

Patients currently taking Rybelsus should be informed and advised about the change in formulation and dose when the new formulation is prescribed or dispensed.

Practices are asked to note the new formulations are unavailable to select in the current EMIS version MK 226. We await version MK228 for this to be rectified and further information will be communicated to practices. Practices are advised not to prescribe until changes to the EMIS system have been made. Rybelsus should be visible on the system from the point at which they update to version MK228. Production of the new formulation will start but there will be an overlap of old and new until the beginning of 2026 when the old product will be discontinued and the new formulation takes over.

Medicines Matters Bulletin Issue 25 Rybelsus (oral semaglutide) risk of medication error update October 2025

MHRA: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

National Patient Safety Alert

Rybelsus� (oral semaglutide): risk of medication error due to introduction of new formulation with increased bioavailability

Semaglutide Wegovy®

Formulary

Solution for injection in pre filled pen

0.25mg, 0.5mg, 1mg, 1.7mg, 2.4mg

Only available via referral to a Tier 3 Weight Management Service.

for NICE TA910 Semaglutide for managing overweight and obesity in young people aged 12 to 17 years.

MHRA: GLP-1 receptor agonists: reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced or discontinued

NICE TA875: Semaglutide for managing overweight and obesity

Tirzepatide

Formulary

Type 2 Diabetes

Preference of agent should be decided based on the clinician’s judgement about patient characteristics. Local specialists have suggested the following:

1. Semaglutide (or other available GLP-1 RAs) may be preferred in patients with lower BMIs e.g. < BMI 35 kg/m2 or patients who have established CVD or are at high risk of CV events and require an agent with proven CV benefit.

2. Tirzepatide may be preferred in patients with higher BMIs e.g. > BMI 40 kg/m2 or who despite optimisation of all other therapies still require further glycaemic control.

Careful consideration MUST be given to stopping tirzepatide if ineffective or not tolerated (evidence of poor tolerance as dose escalates). Tirzepatide should be reviewed after 6 months, and the deprescribing of other agents, e.g. sulfonylureas and gliptins, should be considered where possible.

As a minimum expectation, it is recommended that tirzepatide is only continued if the adult with type 2 diabetes has had a beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c and weight loss of at least 3% of initial body weight in 6 months).

Managing overweight and obesity

LSCMMG: Mounjaro� (Tirzepatide) for Type 2 Diabetes Position Statement

NICE TA924: Tirzepatide for treating type 2 diabetes

Tirzepatide: Mounjaro� (tirzepatide) for managing overweight and obesity in primary care

Insulin glargine/lixisenatide

Formulary

100iu/mL pre-filled pens