Clinical Guidelines

The following guidelines have been approved by the Nottinghamshire Area Prescribing Committee and the relevant secondary care trust(s) Drugs and Therapeutics Committee(s) (D&TCs).

They have been developed in association with the relevant clinicians in primary, secondary and tertiary care (where applicable).

Please click here if you would like the NAPC to consider any clinical guidelines you are developing.

Contents

Allergy Anticoagulants Cardiovascular Continence & Stoma Dependence Dermatology Diabetes Endocrine Eye Gastroenterology Haematology High Cost Drugs Mental Health Neurology Nutrition Obstetrics & Gynaecology Pain Palliative Care Prescribing & Prescription Governance Renal Respiratory Transgender Urology Woundcare Miscellaneous

Allergy

• Allergic Rhinoconjunctivitis Primary Care Pathway

  (713 kb)

  Review date: May 2029
• Cows Milk Allergy - Quick Reference Guide

  (181 kb)

  Review date: May 2028
• Cows Milk Allergy Guidelines

  (689 kb)

  Review date: May 2028
• Cow’s Milk Protein Allergy Focused Clinical History Form for Healthcare Professionals

  (398 kb)

  Review date: May 2028
• Urticaria & Angioedema Primary Care Pathway

  (292 kb)

  Review date: June 2029

Anticoagulants

• Anticoagulants in AF

  (1266 kb)

  Review date: May 2028
• Direct Oral Anticoagulants for DVT and PE - Prescribing Information

  (399 kb)

  Review date: May 2028
• Enoxaparin Info Sheet

  (297 kb)

  Review date: Jan 27
• Warfarin Prescribing Information

  (406 kb)
• Acute Thromboembolism in Pregnancy

  (215 kb)

  Review date: March 2028
• Thromboprophylaxis in Pregnancy

  (304 kb)

  Review date: March 2028

• Living with Anticoagulation - Warfarin

• Living with Anticoagulation - DOACs

• Antimicrobial Guidelines
• Antimicrobial Bulletins
• Palliative Care Stockist Scheme
• Covid
• Greener NHS
• Deprescribing and Polypharmacy

Cardiovascular Resources

• Heart Failure Guideline

  (452 kb)

  Review date: February 2028
• Hyperlipidaemia Guidelines - Summary of National Guidance for Lipid Management for Primary and Secondary Prevention of CVD

  (282 kb)

  Review date: March 2026
• Hyperlipidaemia Management - Statin Intolerance Pathway

  (236 kb)

  Review date: Jan 2024
• Hypertriglyceridaemia Guideline

  (203 kb)

  Review date: July 2027
• Blood Pressure and Heart Rate Monitoring in Children

  (486 kb)

  Review date: July 2026
• Inclisiran Prescribing Information Sheet

  (169 kb)

  Review date: Nov 2026
• Midodrine Monitoring Guidance

  (209 kb)

  Review date: July 2028

Cardiovascular Shared Care Protocols

Cardiovascular Patient Information Leaflets for Amiodarone and Dronedarone. 

Continence and Stoma

• Stoma Ancillaries Items Formulary

  (212 kb)

  Review date: June 2027
• Nottingham & Nottinghamshire Continence Appliance Formulary

  (1160 kb)

  Review date: See individual sections

Dependence

• Primary Care Alcohol Use Guideline

  (603 kb)

  Review date: January 2029
• Take-Home Naloxone - prescriber information sheet

  (132 kb)

  Review date: July 2027

 

 

Recording of Heart Failure guidelines update - Protected Learning Time – 11th June-2025 

00:00 Dr Bara Erhayiem (Consultant Cardiologist, Nottingham University Hospitals)- Contemporary Management of Heart Failure

1:30:29 Lynsay Hayes (Heart Failure Specialist Nurse at Sherwood Forest Hospitals)- One Stop Heart Failure Clinic at Kings Mill Hospital

 

 

Dermatology

• Rosacea guideline

  (417 kb)

  Review date: June 2029
• Barrier Preparations Formulary

  (319 kb)

  Review date: Feb 2028
• Emollient Formulary

  (297 kb)

  Review date: June 2027
• Management of Psoriasis (Adult & Children) in Primary Care

  (424 kb)

  Review date: Jan 2027
• Topical Tacrolimus for Facial Vitiligo

  (107 kb)

  Review date: Jan 2029

• Acitinic (Solar) Keratosis Guidance - Primary Care Dermatology Society

• Dermatology Shared Care Protocols

• Dermatology Patient Information Leaflets

Diabetes

• Blood Glucose Testing Meters Formulary - N&N ICB

  (455 kb)

  Review date: March 2029
• Diabetes - Type 2 Treatment Algorithm

  (1142 kb)

  Review date: May 2026
• Diabetes Type 2 - NICE NG28 implementation holding statement

  (139 kb)
• Continuous Glucose Monitoring Devices - commissioning policy

  (258 kb)
• Freestyle Libre and Dexcom One Prescribing Criteria

  (205 kb)

  Review date: November 2028
• Continuous Glucose Monitoring Devices - device selection principals

  (622 kb)
• Continuous Glucose Monitoring - HCP training materials

  (4260 kb)
• Hybrid Closed Loop - Commissioning Policy

  (368 kb)
• Hybrid Closed Loop - Educational Resources

  (978 kb)
• Hybrid Closed Loop FAQs for patients

  (167 kb)
• Treatment options for diabetic hypoglycaemia in children and adults: Position statement.

  (152 kb)

  Review date: April 2027
• Frequency of blood glucose self-monitoring: Adults

  (298 kb)

  Review date: March 2028

Endocrine

• Liothyronine for Hypothyroidism Position Statement

  (237 kb)

  Review date: July 2026
• Steroid Card Patient Letter

  (23 kb)
• Steroid Emergency Card and Steroid Treatment Card - Guidance on Use

  (263 kb)

  Review date: Nov 2027
• Testosterone Information Sheet

  (150 kb)

  Review date: Jan 2027

Eye

• Eye Lubricant Formulary

  (190 kb)

  Review date: Oct 2025
• Eye Lubricant Prescribing Advice

  (147 kb)

  Review date: Oct 2025

Gastroenterology

• Aminosalicylates in IBD in Adults - Information Sheet

  (265 kb)

  Review date: Jul 2028
• Constipation - Links to National Guidelines

  (182 kb)

  Review date: April 2029
• Gastroprotection (with PPI) for Patients on NSAID or Antiplatelet

  (207 kb)

  Review date: Jan 2028
• Proton Pump Inhibitor Choice in Children

  (362 kb)

  Review date: May 2029
• Ondansetron for IBS-D - Prescribing Information Sheet

  (106 kb)

  Review date: June 2027
• Management of Irritable Bowel Syndrome (IBS) in Primary Care

  (282 kb)

  Review date: April 2028

• Inflammatory Bowel Disease shared care protocols

• Inflammatory Bowel Disease patient information leaflets

• Post Bariatric Surgery, Monitoring and Medication (Derbyshire)

Haematology

• Vitamin B12 Treatment Guideline

  (125 kb)

  Review date: July 2028

High Cost Drugs

• High Cost Drugs - Atopic Dermatitis treatment algorithm

  (150 kb)

  Review date: December 2026
• Biosimilar Position Statement

  (193 kb)

  Review date: December 2026
• High Cost Drugs - Psoriatic Arthritis treatment algorithm

  (157 kb)

  Review date: December 2026
• High Cost Drugs - Psoriasis treatment algorithm

  (130 kb)

  Review date: December 2026
• High Cost Drugs - Rheumatoid Arthritis treatment algorithm

  (157 kb)

  Review date: December 2026
• High Cost Drugs - Ankylosing Spondylitis and non-radiographic axial spondyloarthritis algorithm

  (164 kb)

  Review date: December 2026

Mental Health Resources

• Agomelatine Prescribing Information Sheet

  (152 kb)

  Review date: Sept 2027
• Antidepressants in Primary Care - Prescribing, Stopping & Swapping

  (348 kb)

  Review date: July 2028
• Antipsychotics - Clozapine Information Sheet

  (295 kb)

  Review date: Sept 2027
• Antipsychotics Prescribing Guideline

  (495 kb)

  Review date: July 2027
• Benzodiazepines and Z-hypnotics: Guidance on Prescribing and Deprescribing

  (395 kb)

  Review date: September 2027
• Bupropion for Severe Depression, prescribing information sheet

  (215 kb)

  Review date: July 2027
• Clonidine for Tic Disorders in Children and Young People

  (177 kb)

  Review date: March 2028
• Daridorexant prescribing information sheet

  (111 kb)

  Review date: Jan 2027
• Dementia - Managing Behaviour and Psychological Problems

  (257 kb)

  Review date: May 2028
• Lithium Prescribing Guideline

  (299 kb)

  Review date: November 2027
• Vortioxetine Information Sheet

  (136 kb)

  Review date: Jan 2029

• ADHD adults shared care protocols

• ADHD adults patient information

• ADHD children and young people shared care protocols

• ADHD children and young people patient information

• Valproate for patients of child-bearing potential shared care protocol

• Valproate decision support tools

Neurology

• Buccal Midazolam Guideline for Patients under Paediatric Care

  (210 kb)

  Review date: May 2029
• Melatonin Use in Sleep Problems in Children

  (568 kb)

  Review date: Nov 2027
• Monoamine-oxidase-B Inhibitors in Patients with Off Periods Without Dyskinesia

  (137 kb)

  Review date: March 2028
• Narcolepsy- Methylphenidate Information sheet

  (143 kb)

  Review date: December 2026
• Modafinil Information Sheet

  (223 kb)

  Review date: December 2026
• Narcolepsy-Dexamfetamine Information Sheet

  (158 kb)

  Review date: December 2026
• Parkinson's Disease - Pramipexole Information Sheet

  (121 kb)

  Review date: Sept 2027
• Parkinson's Disease - Ropinirole Information Sheet

  (101 kb)

  Review date: July 2027
• Parkinson's Disease - Rotigotine Information Sheet

  (131 kb)

  Review date: July 2027

• Neurology shared care protocols

• Neurology patient information leaflets

Nutrition including Oral Nutritional Supplements

• Oral Nutritional Supplements (ONS) in Adults - Food First Leaflet

  (379 kb)
• Oral Nutritional Supplements (ONS) in Adults - Quick Reference

  (243 kb)

  Review date: Sep 2026
• Oral Nutritional Supplements (ONS) in Adults - Care Home Request Form

  (248 kb)

  Review date: Sep 2026
• Oral Nutritional Supplements (ONS) in Adults - Full Guideline

  (567 kb)

  Review date: Sep 2026
• Infant Feeds - Premature Infants

  (259 kb)

  Review date: Jan 2027
• Lactose Intolerance Guideline

  (200 kb)

  Review date: Aug 2027
• Lactose Intolerance - Patient Information Leaflet (secondary intolerance)

  (214 kb)

  Review date: Aug 2027
• Vitamin D Guideline for Adults

  (341 kb)

  Review date: May 2027
• Vitamin D Guideline for Children

  (259 kb)

  Review date: May 2027

Obstetrics and Gynaecology

• HRT- Quick reference guide and FAQs

  (693 kb)

  Review date: January 2029
• Hypothyroidism in Pregnancy Primary Care Guidance

  (217 kb)

  Review date: Sep 2027
• Nausea and Vomiting in Pregnancy

  (97 kb)

  Review date: January 2027
• Testosterone for Postmenopausal Women- Information Sheet

  (91 kb)

  Review date: Jan 2027
• Drospirenone Prescribing Information Sheet

  (240 kb)

  Review date: March 2027
• Domperidone for Lactation Stimulation - Template Letter

  (26 kb)

  Review date: May 2028
• Relugolix-estradiol-norethisterone (Ryeqo®) and linzagolix (Yselty®) Prescribing information sheet

  (180 kb)

  Review date: November 2028

• Domperidone for lactation stimulation Prescribing information- now see SPS guidance

Pain

• Overarching Pain Guidelines - Management of Chronic Pain in Adults

  (216 kb)

  Review date: May 2029
• Cluster Headaches - Home Oxygen Pathway

  (208 kb)

  Review date: November 2028
• Neuropathic Pain Guideline

  (460 kb)

  Review date: May 2028
• Opioid Deprescribing in Persistent Non-Cancer Pain

  (164 kb)

  Review date: March 2029
• Opioids for Non-Cancer Pain in Adults

  (98 kb)

  Review date: May 2028
• Adult Headache Pathway

  (309 kb)

  Review date: May 2029

Palliative Care

• End of Life Guidance

  (938 kb)

  Review date: March 2029
• Palliative Care Pocketbook

  (355 kb)

  Review date: Nov 2026
• Heart Failure - Palliative Care Guidance

  (503 kb)

  Review date: Jul 2027
• Parecoxib 40mg injection for palliative care pain management in adults

  (196 kb)

  Review date: February 2029

Prescribing and Prescription Governance

• Inappropriate Request - Template Letter

  (20 kb)
• Out of Area Prescribing Requests - Supporting Information

  (261 kb)

  Review date: May 28
• Out of Area Prescribing Requests

  (120 kb)

  Review date: May 28
• Unlicensed "Specials" - Alternatives and Options for Prescribing (PrescQIPP)

  (249 kb)

  Review date: Dec 2026
• Prescribing and Supply of Unlicensed and Off-label Medication Policy

  (306 kb)

  Review date: Dec 2026

• Emergency supply of medication - NHS Nottingham and Nottinghamshire ICB

Renal

• Sick Day Rules Guidance

  (648 kb)

  Review date: Nov 2028
• Sick Day Rules Patient Leaflet - Please print and complete for the patient to keep

  (583 kb)

  Review date: Nov 2028
• Clinical Pathway For The Use Of SGLT2 inhibitors In Chronic Kidney Disease(CKD) and Type 2 Diabetes(T2DM)

  (163 kb)

  Review date: November 2027
• Finerenone For Treating Chronic Kidney Disease (CKD) In Type 2 Diabetes - Prescribing Information Sheet

  (205 kb)

  Review date: March 2027
• Guidelines for management of Chronic Kidney Disease (CKD) for adults

  (1161 kb)

  Review date: November 2027

• Renal Shared Care Protocols

• The following resources can be used to calculate renal function:

• Calculating kidney function – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice, updated April 2024.

• Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions - GOV.UK, updated Oct 2019.

• Prescribing in renal impairment | Medicines guidance | BNF | NICE.

Respiratory

• Asthma in Children 5 to 11 years old

  (416 kb)

  Review date: January 2028
• Asthma in Adults and Children over 12 years old

  (520 kb)

  Review date: May 2028
• Salbutamol Quick Guide - prescribing for Asthma in Adults and Children 12 years old and over

  (84 kb)

  Review date: July 2028
• Bronchiectasis Self Management Plan

  (221 kb)

  Review date: September 2028
• COPD Emergency Supply Medicines – Prescribing Information

  (410 kb)

  Review date: May 2029
• COPD Guideline

  (784 kb)

  Review date: July 2027
• COPD Self Management Plan

  (141 kb)

  Review date: September 2028
• Colistimethate for Non-CF Bronchiectasis - Information sheet

  (363 kb)

  Review date: May 29

• COPD - Action Plan for Patients with Learning Difficulties

• Greener NHS - Respiratory

• Your Asthma Action Plan

• Children Asthma Action Plan -Your child’s asthma action plan | Asthma + Lung UK

Transgender

• Information and Guidance on Prescribing in Transgender Health

  (684 kb)

  Review date: June 2027

• Transgender collaborative care protocol

• Feminising Hormone Treatment for Adults

• Masculinising Hormone Treatment for Adults

Urology

• Desmopressin (Noqdirna) Prescribing Information Sheet

  (216 kb)

  Review date: Sep 2028
• Male LUTS clinical guideline

  (366 kb)

  Review date: May 2028
• Overactive Bladder Clinical Guidance

  (248 kb)

  Review date: Jan 2029

Woundcare

• Woundcare Formulary CityCare

  (363 kb)

  Review date: April 2026
• Woundcare Formulary County

  (1625 kb)

  Review date: January 2026
• Nottinghamshire wound care prescription request form for nursing homes in the county

  (308 kb)

  Review date: January 26
• Nottinghamshire wound care prescription request form for nursing homes in CityCare

  (288 kb)

• APC Wound infection guideline 

• Prescription Requests for compression wraps City practices

Miscellaneous

• Fludrocortisone for Orthostatic Hypotension

  (313 kb)

  Review date: Aug 2027
• Gonadorelin Analogues for Prostate and Breast Cancer - Position Statement

  (346 kb)

  Review date: August 2027
• Osteoporosis Guideline

  (589 kb)

  Review date: December 2027
• Biosimilar

  (278 kb)

• Gynaecomastia Guidelines