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PAD Profile : Semaglutide (oral) - Diabetes Mellitus
Traffic Light Status
Status 1 of 3.
- Tablets
Status 2 of 3.
- Not Specified
Status 3 of 3.
Guidelines
The following guidelines are available for this indication.
Other Drugs
- Dapagliflozin
- Exenatide
- Insulin detemir
- Liraglutide
- Pioglitazone hydrochloride
- Sitagliptin
- Vildagliptin
- Saxagliptin
- Linagliptin
- Alogliptin
- Empagliflozin
- Xultophy
- Metformin hydrochloride
- Insulin Glargine - Toujeo
- Dulaglutide
- Insulin glargine - Abasaglar
- Insulin degludec
- Insulin aspart - NovoRapid
- Insulin glulisine - Apidra
- Insulin Lispro - Admelog
- Gliclazide
- Acarbose
- Insulin Aspart - Trurapi
- Repaglinide
- Glimepiride
- Glipizide
- Glibenclamide
- Tolbutamide
- Albiglutide
- Insulin pump - Type 1 diabetes
- Semaglutide
- Ertugliflozin
- Suliqua (Insulin glargine/lixisenatide)
- Glyxambi (Linagliptin/empagliflozin)
- Sotagliflozin
- Tirzepatide
- Metformin hydrochloride/sitagliptin
- Metformin hydrochloride/vildagliptin
- Alogliptin/metformin
- Linagliptin/metformin
- Empagliflozin/metformin
- Canagliflozin/metformin
- Dapagliflozin/metformin
- Saxagliptin/dapagliflozin
- Metformin hydrochloride/pioglitazone
- Diazoxide
- Glucose
- Soluble insulin - Hypurin porcine neutral
- Insulin Lispro - Lyumjev
- Insulin Lispro - Humalog
- Insulin Aspart - Fiasp
- Soluble insulin - Humulin R
- Soluble insulin - Humulin S
- Soluble insulin - Actrapid
- Insulin glargine - Lantus
- Insulin glargine - Semglee
- Isophane (neutral insulin) - hypurin porcine 30/70
- Biphasic Isophane Insulin - Humulin M3
- Biphasic Insulin Aspart - Novmix 30
- Biphasic Lispro Insulin - Humalog Mix 25
- Biphasic Lispro Insulin - Humalog Mix 50
- Isophane Insulin - Hypurin Porcine Isophane
- Isophane Insulin - Insulatard
- Isophane Insulin - Humulin I
Other Indications
- Diabetes Mellitus
- Weight management in adults
- Prevention of cardiovascular events
- Weight management in adolescents
Additional Documents
Committee Recommendations
Do not prescribe semaglutide tablets (Rybelsus) for the treatment of obesity.
Guidelines for weight management can be found here: Guidelines : Weight management in adults (res-systems.net)
For use in diabetes - see recommendations below.
The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the use semaglutide (oral formulation) with a GREEN (see narrative) traffic light status.
If a GLP-1 receptor antagonist is clinically indicated,the primary care prescriber after discussion with the patient should strongly recommend initiation of a GLP-1 RA injection because of the evidence for cardiovascular benefit for that formulation.
Semaglutide (oral) is available for patients in a niche group where a GLP-1 RA injection cannot be used (due to clinical reasons or patient preference). [Link here to semaglutide injection page on PAD here:
https://surreyccg.res-systems.net/PAD/Search/DrugConditionProfile/6238]
Oral formulation is not the preferred route of administration, due to poor bioavailability and a high incidence of gastrointestinal side effects.
The patient should be advised about the advantages of the injectable form of semaglutide over the oral form because of improved outcomes data and greater certainty that the correct dose will be administered.
Oral semaglutide should be reserved only for those few patients for whom a GLP-1 Receptor Agonist is the treatment of choice and who are:
- unable to tolerate, or unsuitable for an SGLT-2 inhibitor
- unable to tolerate the injectable preparation eg allergy to an ingredient in the injection
- psychologically unable to consider administration of a s.c. injection (even if someone else administers it)
- unable to self-administer the injection, due to physical disability or dexterity problems.
An alternative oral option for ths group of patients for consideration is a SGLT2 inhibitor, In line with current NICE guidance for managing type 2 diabetes, patients should be assessed after 6 months at the maximum tolerated dose. If the patient does not achieve targets of a 1% reduction in HbA1c and 3% reduction in weight, the treatment should be reviewed with a view to discontinuation of treatment and switching to another appropriate therapy.