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

First line GLP-1 agonist

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.

Managing overweight and obesity.

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

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

First line GLP-1 agonist.

Prescribe by brand.

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.  

In September 2025 all practices received a Direct Healthcare Professional Communication from Novo Nordisk regarding a change to the formulation of Rybelsus (oral semaglutide). At that time the EMIS clinical system had not been adequately updated to allow practices to prescribe the new formulations and we advised practices to refrain from switching patients over until further notice. 

Over the last few weeks these updates to the EMIS system have been implemented and supplies of the new formulations have now started to make their way into distribution chains.  

Novo Nordisk is replacing the initial formulation (3 mg, 7 mg, 14 mg tablets) of Rybelsus with the new formulation (1.5 mg, 4 mg, 9 mg tablets). Healthcare professionals should be aware that the original formulation is anticipated to be available until approximately 31st January 2026 however, original formulation stock of imported Rybelsus may be within supply chains beyond this date.  

There is a risk of patient harm arising through medication error during the transition period where the original and new formulation of Rybelsus tablets, which have different stated mg doses but are bioequivalent, will both be available on the market. Medication error may result in overdose if healthcare professionals prescribe more than one tablet per day of the new formulation to try to match the dose to the old strengths. This could affect disease control and increase the risk of side effects e.g. nausea, vomiting and diarrhoea.  

Please find the link here for further advice for Healthcare professionals from the MHRA  

• The new formulation of Rybelsus has increased bioavailability therefore lower strength tablets achieve the same drug exposure and clinical effect as the previous formulation.  
• The Product Information has been updated to explain the difference between the two formulations and enable readers to identify the equivalent doses across formulations with bioequivalent doses.  
• Details of the new formulation can also be found in the Direct Healthcare Professional Communication distributed by the Marketing Authorisation Holder in September 2025.  
• Rybelsus tablets have been replaced with a new formulation with increased bioavailability, which is bioequivalent to the initial formulation as described in the table below:  

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.

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

100iu/mL  pre-filled pens