Medicines Optimisation Team

 

Prescribing available GLP-1 receptor agonists during national shortages:

Prescribing available GLP-1 receptor agonists during national shortages:

In January 2024, a National Patient Safety Alert (NatPSA) on the shortage of GLP-1 receptor agonists  noted that supply of GLP-1 RAs was not expected to return to normal until at least the end of 2024. The national alert contained actions for clinicians and prescribers of GLP-1 RAs and should be read in full. Local communication, including support for practices in BSW via a prescribing incentive scheme were issued by the BSW medicines optimisation team.

In March 2024, DHSC cascaded a further Medicine Supply Notification Medicine Supply Notification: Supply issues with multiple GLP-1 RA products - Community Pharmacy England (cpe.org.uk) summarising:

Semaglutide

• Semaglutide (Ozempic®) 0.25mg and 1mg pre-filled pens (PFP) are available but will have intermittent supply throughout 2024. New patient initiations cannot be supported.
• Semaglutide (Ozempic®) 0.5mg PFP is out of stock until early June 2024. This product will then have intermittent supply until the end of 2024. New patient initiations cannot be supported.
• Semaglutide (Rybelsus®) 3mg, 7mg and 14mg tablets are available and can support increased demand for both new patient initiations and any patients unable to obtain their existing GLP-1 RA therapy.

Dulaglutide

• Dulaglutide (Trulicity®) 0.75mg, 1.5mg, 3mg and 4.5mg PFP are available but will have intermittent supply throughout 2024. New patient initiations cannot be supported.

Liraglutide

• Liraglutide (Victoza®) 6mg/ml PFP is out of stock until end of 2024.

Exenatide

• Exenatide (Bydureon BCise®) 2mg/0.85ml prolonged-release PFP remain available for patients stabilised on therapy but are not able to support new patient initiations.
• Exenatide (Byetta®) 5micrograms/0.02ml and 10micrograms/0.04ml PFP will be discontinued at the end of March 2024.

Tirzepatide

• Tirzepatide (Mounjaro® Kwikpens®) 2.5mg/0.6ml and 5mg/0.6ml solution for injection 2.4ml PFP (containing 4 doses) are now available and can support both new patient initiations and any patients unable to obtain their existing GLP-1 RA therapy.
• Higher strengths of tirzepatide (Mounjaro® Kwikpens®) will become available in the coming months (7.5mg/0.6ml, 10mg/0.6ml, 12.5mg/0.6ml and 15mg/0.6ml solution for injection 2.4ml PFP).

 

And advising that clinicians should:

• only prescribe GLP-1 RAs for their licensed indication;
• proactively engage with patients established on GLP-1 RAs impacted by shortage and consider prioritising for review based on the criteria set out in clinical guidance and:
• discuss stopping the GLP-1 RA if patients have not achieved treatment goals as per NICE NG28;
  • do not double up a lower dose preparation where a higher dose preparation of a GLP-1 RA is not available;
  • do not switch between strengths of a GLP-1 RA solely based on availability; and
  • do not prescribe more than one month’s supply unless there is clear reason to do so in order that the risks to the supply chain are minimised and the needs of patients acknowledged (see supporting information in MSN).

 

Where patients are prescribed Victoza® or Byetta® or where patients are unable to obtain Ozempic® or Trulicity® for 2 weeks or more, prescribers should:

• consider prescribing either Rybelsus® tablets or Mounjaro® KwikPens® (ensuring that the patient is prescribed appropriate needles), which can support the market during this time, if appropriate;
• if prescribing Mounjaro® or Rybelsus®, ensure that the patient is not intolerant to any of the excipients (refer to product SPC) and that the dose regimen, including administration volumes where applicable is specifically discussed (see supporting information); and
• if the above options are not considered appropriate, or if prescribers in primary care require further clinical advice, they should liaise with specialists.

 

For up-to-date stock information, please continue to utilise the national data hosted by SPS Medicine Supply Tool Shortage of GLP-1 receptor agonists used in the management of type 2 diabetes (semaglutide, dulaglutide, liraglutide, exenatide) – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice [note SPS website requires users to register and log in) and the resources suggested below:

Joint PCDS and ABCD guidance: GLP-1 RA National Shortage

GLP-1-stock-shortage-patient-information-leaflet-without-cover-letter

GLP-1-stock-shortage-patient-information-leaflet-with-cover-letter

Advice for those stopping GLP1's NHS leaflet - produced by Somerset ICB and approved for use across BSW

Diabetes UK factsheet for people affected by shortages: Diabetes UK - FAQS - GLP-1 RA Shortages