Best value preferred dipeptidylpeptidase-4 inhibitor (DPP4i or gliptin)
Generic Sitagliptin is the first line, best value DPP4i in Dorset.
NHS Dorset is asking PCN teams to switch patients on the below DPP4 inhibitors to generic Sitagliptin:
- Alogliptin (Vipidia)
- Linagliptin (Trajenta)
- Saxagliptin (Onglyza)
- Vildagliptin (Galvus)
- Januvia brand of sitagliptin
Clinical appropriateness should always be considered, and any switches should be discussed and agreed with patients through shared decision-making.
- Sitagliptin has comparable efficacy and similar or better tolerability to other DPP4i medicines
- NICE recommends that the medicine of lowest acquisition cost should be used
- Generic sitagliptin is 90% less expensive than other DPP4i medicines
- Switching to generic Sitagliptin will help PCN teams care for patients within their NHS England financial envelope and hence, release funds to improve care for unmet needs.
- Early switching is recommended to maximise cumulative in year cost savings.
Notify community pharmacy colleges of the intention to switch to the best value DPP4i generic sitagliptin.
Work with community pharmacy colleagues to ensure sufficient stock is available to support the switching programme and minimise disruption to patients, GP and community pharmacy teams.
Run the SystmOne searches provided to identify existing patients prescribed a DPP4i other than generic sitagliptin:
Dorset SystmOne GPs>PINH 26 27 / F5 Other finance options / PINH 2627 DPP4i RPT with T2DM (excluding <18years) consider switch to sitagliptin
A risk management approach should be taken, to any batch-switching arrangement, which includes safeguards which enable patients to have a review, should they have any queries or changes to their condition.
Agree a patient-centred process for switching patients within the practice
Exclusion criteria in SystmOne
- < 18 years of age
- Any indication other than type 2 diabetes
Exclusion criteria which will require clinical review
- Renal transplant or dialysis patients
- Current or recent acute kidney injury (AKI) in last 6 months
- Pregnancy and breastfeeding
- Concomitant use of digoxin (CKS states monitor for digoxin toxicity)
- Severe hepatic impairment
- Previous intolerance or allergy to sitagliptin or its excipients
- Previous treatment failure or contraindication to sitagliptin
Special considerations:
When making any change to a medication, please ensure:
- Any potential drug interactions, cautions and contraindications are considered.
- All relevant clinical monitoring parameters have been taken in the last 12 months (last 6 months for renal function) and reviewed, note poorly controlled diabetes should be highlighted for review.
- Any necessary dose adjustments have been made.
- Any necessary follow up tests / appointments booked.
Where clinically appropriate, after a shared decision-making process with patients, switch patient to generic sitagliptin.
How to communicate this to patients:
- Use the template patient text message and letter in SystmOne to notify patients of the change. Ensure patient is counselled appropriately.
Patient text message:
"NHS Dorset has asked GP teams to change prescriptions for Alogliptin, Linagliptin, Saxagliptin, Vildagliptin or Januvia, to sitagliptin tablets, which are from the same class of medicines (DDP4i's), offer the same effect and safety as your current prescription but is the 1st choice in Dorset. Please read the label and patient information leaflet before starting this new medication. Finish your old supply before starting sitagliptin and take the 1st dose of sitagliptin when the next dose of your previous medication would have been due. If you have any questions speak to your community pharmacist or GP."
Template patient letter: In the SystmOne communications annexe.
Overview | Type 2 diabetes in adults: management | Guidance | NICE
Medication formulation / Branded to generic recommended switching
NHS Dorset is asking PCN teams to review the brand and prescribed formulation of medicines, where multiple brands / formulations exist.
A table of suggested switches can be found in the resources section.
Some brands and formulations of the same medicine offer no clinical advantage, at an increased cost. The potential savings achieved through formulation switching, can enable the NHS budget to be used to greater benefit the Dorset population.
A table of suggested switches can be found in the resources section.
Review the table of proposed medication switches in the resources section, to identify appropriate switches.
Run SystmOne searches to help PCN teams identify patients suitable for product switch within the PCN:
Dorset SystmOne GPs> PINH Finance 2627>Optional medication changes>
Switch patients to the NHS Dorset recommended formulations, taking into consideration any dosage instruction changes which may be required because of the formulation change.
As with all product switches, not all patients will be appropriate for switch.
Where patients are not eligible for product switch, this should be recorded in the patient record e.g. where increasing tablet/capsule burden is not appropriate, patients requiring specific products due to visual impairment, licensing, contraindication, drug interaction, intolerance/allergy to excipients, dietary preference, religious grounds, swallowing issues etc.
Note, where a formulation switch requires a tablet formulation to be halved, the patient’s ability to half a tablet must be considered. Patients are able to purchase a pill cutter form their Community Pharmacy.
Communicate the change to patients using the Template patient letters and text messages within SystmOne:
Template text messages can be found within SystmOne>Msg presets> Medication Management>Formulation> specific template for each product listed
Template Letters can be found within SystmOne>Word letter templates>Dorset CCG> Medicines Management> Formulation> specific template for each product listed
Table of suggested additional cost savings opportunities – coming soon
