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National Patient Safety Alert – GLP-1 receptor agonists

Friday 9th February 2024

A new National Patient Safety Alert has been issued in relation to GLP-1 receptor agonists (GLP-1 RA).  Please note the information contained in this communication supersedes the information and National Patient Safety alert that was sent out in July 2023.

  • 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

Supplies of GLP-1 RAs continue to be limited with supply not expected to return to normal until at least the end of 2024.

Please note the following:

  • Rybelsus® (semaglutide) tablets are now available in sufficient quantities to support initiation of GLP-1 RA’s in people with Type 2 diabetes (T2DM) in whom new initiation of GLP-1 RA therapy would be clinically appropriate.
  • Byetta® (exenatide) solution for injection pre-filled pens (both strengths) will be discontinued in March 2024.
  • Victoza® (liraglutide) is expected to be out of stock until the end of 2024
  • Saxenda® (liraglutide) and Wegovy® (semaglutide) remain available for weight loss via specialist weight management services.

Some new actions for practices have been published (see below).  The deadline for these actions is 28th March 2024.

ACTION FOR PRACTICES

  1. GLP-1 RAs should only be prescribed for their licensed indication.  Existing stock must be conserved for patients with T2DM to mitigate the risk of impaired access to access to treatment and increased risk in diabetes-related complications.
  2. Prescribe Rybelsus® tablets for new initiations of a GLP-1 RA (in line with NICE NG28)
  3. Identify patients prescribed Byetta® and Victoza® injections and, in line with NICE NG28, switch to Rybelsus® tablets.
  4. Counsel patients on any changes in drug, formulation and dose regimen, where appropriate.  Please see page 2 of the alert for further clinical information.  
  5. Engage with patients established on affected GLP-1 RAs and consider prioritising for review:
    • Discuss stopping GLP-1 RA if patients have not achieved treatment goals as per NICE NG28 / CG189
    • Do not prescribe excessive quantities to minimise risk to the supply chain whilst acknowledging the needs of the patients
    • 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

Use the principles of shared decision making where an alternative agent needs to be considered, as per NICE guidelines and in conjunction with the clinical guidance.

Support patients to access structure education and weight management programmes where available.

Patients should also be signposted to the GM shortages webpage which contains help and advice that can support them during the ongoing shortage.

Please be aware that the situation is rapidly changing, and we will provide updates as and when receive them.  In the meantime, if you have any questions about a specific patient,

Or If you need any help with completing EMIS searches to identify patients prescribed GLP-1 RA’s, please contact your Medicines Optimisation Technician.

Friday 9th February 2024

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