Patients with type two diabetes can be initiated on Mounjaro Kwikpens (tirzepatide) or Rybelsus tablets (semaglutide), according to a Department of Health and Social Care (DH) medicine supply notification announced by Community Pharmacy England (CPE) this week (March 18).

According to CPE, many glucagon-like peptide-1 receptor agonist (GLP-1 RA) medicines for type two diabetes management will remain in short supply throughout 2024.

CPE said that new patients should not be started on Ozempic injections (semaglutide), Trulicity (dulaglutide) or Bydureon BCise (exenatide).

It added:

• There will be “intermittent supply” of the 0.25mg, 0.5mg, and 1mg Ozempic solutions – with the 0.5mg dose out of stock until early June - and the 0.75mg, 1.5mg, 3mg and 4.5mg Trulicity solutions throughout 2024
• Victoza (liraglutide) 6mg/ml solution for injection in a pre-filled pen is out of stock until the end of 2024
• Byetta (exenatide) 5micrograms/0.02ml and 10micrograms/0.04ml pre-filled pens will be discontinued at the end of this month

However, it said that in the coming months, “higher strengths of tirzepatide” in the form of Mounjaro Kwikpens (7.5mg/0.6ml, 10mg/0.6ml, 12.5mg/0.6ml and 15mg/0.6ml solutions) will be available for patients.

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The 2.5mg/0.6ml and 5mg/0.6ml solutions of Mounjaro Kwikpens and Rybelsus (semaglutide) 3mg, 7mg and 14mg tablets are also “now available” and “can support” new initiations and switches, it added.

And Bydureon BCise exenatide 2mg/0.85ml prolonged-release pre-filled pens are available for patients “stabilised on therapy” only, according to CPE.

New guidance

New guidance from the Primary Care Diabetes Society (PCDS) and Association of British Clinical Diabetologists (ABCD) updated this month also highlighted that other GLP-1 RA products are available to adults with type two diabetes that cannot obtain their “original” medication.

PCDS and ABCD this week (March 18) published the updated guidance to help clinicians choose “alternative glucose-lowering therapies” during the “ongoing national shortage”. 

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According to the document, prescribers should “consider prescribing Rybelsus tablets or Mounjaro Kwikpens” to patients prescribed Victoza or Byetta or who have been “unable to obtain Ozempic or Trulicity for two weeks or more”.

And it said that they should not prescribe more than one month’s supply “unless there is clear reason to do so” to ensure the “risks to the supply chain are minimised” or prescribe GLP-1 RAs for anything other than their licensed indication.

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“Local supply chain issues may be overcome by attending an alternative pharmacy [and] this should be considered before switching therapies,” it added.

In January, the DH announced that GLP-1 RA supply issues would continue “until at least the end of 2024”.

At the time, it said that “clinicians and prescribers” should “identify patients prescribed Byetta and Victoza injections” and switch them to Rybelsus tablets by March 28 and that these tablets should also be prescribed for all new initiations.