Update, 8 April 2024: The Scottish Medicines Consortium (SMC) has approved the use of Mounjaro, the brand name for tirzepatide, to treat people living with type 2 diabetes in Scotland.
This follows the NHS England announcement in March which confirmed people in England living with type 2 diabetes can be offered Mounjaro as a diabetes treatment, or offered Mounjaro if they are unable to access their usual GLP-1 RA medication.
Supply issues with glucagon like peptide-1 receptor agonists (GLP-1 RAs) are not expected to ease until late 2024, and these shortages have impacted supplies of GLP-1 RAs including Ozempic and Trulicity.
Previously, in January 2024, NHS England and the Department for Health and Social Care (DHSC) opened up new prescribing of Rybelsus (semaglutide) tablets to people living with type 2 diabetes who could benefit.
Now, to help ease these shortages further, Mounjaro can also be prescribed to people living with type 2 diabetes in England who are unable to obtain Ozempic, Trulicity or other GLP-1 RA medications.
We are pleased to see the opening up of Mounjaro as a treatment for people with type 2 diabetes. Though we remain concerned about the intermittent supply and ongoing shortages of GLP-1 medications which are having serious implications for many people with type 2 diabetes.
What is Mounjaro?
Mounjaro is a GLP-1 analogue that is combined with a GIP analogue (short for glucose-dependent insulinotropic polypeptide). It is manufactured by pharmaceutical company Eli Lilly.
Tirzepatide is administered through once-weekly injections. It works by activating both GLP-1 and GIP receptors to increase the level of incretins in the body. These incretin hormones increase the production of insulin in the body and decrease the glucose produced by the liver, lowering blood glucose.
Research into the use of tirzepatide to treat type 2 diabetes found it led to greater improvements in blood glucose management and weight loss when compared to other type 2 diabetes medications.
What will Mounjaro be used for?
The National Institute for Health and Care Excellence, or NICE for short, recommends that Mounjaro can be prescribed to adults with type 2 diabetes when using three medications has not been effective in managing diabetes, or you have not been able to take the medications. This might be because of side effects or because of other medical conditions.
Mounjaro is only prescribed for people who also have a BMI of 35kg/m2 or more and additional psychological or other medical conditions that are related to obesity.
It could also be prescribed to people living with type 2 diabetes who have a BMI below 35kg/m2 where using insulin would affect your occupation due to the risk of hypoglycemia, or for those who would see improvements in other obesity-related health issues with weight loss.
This should be an individual assessment that includes how this will fit into your current treatment plan, and considers any diet or activity programme that you are following, the risk of side effects, the dose you’ll need and your personal choices.
You should only be given a prescription for Mounjaro following an assessment by your healthcare team to make sure that you meet the criteria and that you’ll benefit from its use.
Is Mounjaro available across the UK?
Mounjaro can now be prescribed within England, Wales and Northern Ireland following approval by NICE for the use of tirzepatide to treat type 2 diabetes. The Scottish Medicines Consortium (SMC) has also now approved the use of tirzepatide to treat type 2 diabetes.
How do you take Mounjaro?
In January 2024, the Medicines and Healthcare Products Regulatory Agency (MHRA) approved a multi-dose version of Mounjaro (tirzepatide) called Mounjaro Kwikpen to treat people with type 2 diabetes.
The Mounjaro Kwikpen comes as a four-dose pre-filled injection pen to be injected as a starting dose of 2.5mg once a week for four weeks.
Lower strengths of Mounjaro are available now through the Mounjaro Kwikpen - 2.5mg/0.6ml and 5mg/0.6ml solution for injection in 2.4ml pre-filled pens (containing four doses). Higher strengths are expected to be made available later this year.
The Mounjaro Kwikpen has also been approved by the MHRA for weight management in people living with obesity or overweight who have weight-related health problems, high blood pressure, high cholesterol or heart problems.
A one-dose Mounjaro pen has also previously been approved.
Though Mounjaro is currently authorised by the MHRA for weight loss, and the Kwikpen is authorised for this application, Mounjaro is yet to receive complete appraisal by NICE and the SMC for weight loss.
A NICE appraisal for Mounjaro to be used for treating overweight and obesity in the NHS is scheduled to be concluded in spring 2024, when we would expect recommendations to be published.
What’s the latest with GLP-1 RA supply issues?
We are concerned about the ongoing shortages of GLP-1 medications which are having serious implications for many people with type 2 diabetes.
We have been raising this with the Department of Health and Social Care and stressing the need for this issue to resolved as a matter of urgency.
We welcomed the government’s guidance to restrict off-label prescriptions of GLP-1 medications while there is an ongoing shortage impacting people with type 2 diabetes, and the National Patient Safety Alert issued in January that permitted people to be initiated onto Rybelsus due to an uplift in supply of that medication.
We also welcome the new guidance that tirzepatide can be prescribed to people with type 2 diabetes who meet the criteria.
Does tirzepatide have side effects?
Like all medications, tirzepatide can have side effects. Common side effects of tirzepatide can include feeling sick, indigestion, constipation and diarrhoea, while less common side effects include pancreatitis and gallstones.
Before starting treatment with tirzepatide, it is important to take individual advice from your healthcare team. You should report any side effects, if you experience any, while taking the medication.
