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

  (197 kb)

  Review date: December 2025
• Cows Milk Allergy - Quick Reference Guide

  (135 kb)

  Review date: May 2028
• Cows Milk Allergy Guidelines

  (504 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

  (366 kb)

  Review date: Jan 2026

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)

• 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 Quick Guide

  (467 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

  (105 kb)

  Review date: Apr 2026
• Midodrine Monitoring Guidance

  (209 kb)

  Review date: July 2028

Cardiovascular Shared Care Protocols

Cardiovascular Patient Information Leaflets for Amiodarone and Dronedarone. 

 

 

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

 

 

Continence and Stoma

• Stoma Ancillaries Items Formulary

  (212 kb)

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

  (996 kb)

  Review date: See individual sections

Dependence

• Alcohol Dependence Guidelines (Primary Care)

  (662 kb)

  Review date: October 2025
• Smoking Cessation - Position Statement

  (96 kb)

  Review date: April 2026
• Take-Home Naloxone - prescriber information sheet

  (132 kb)

  Review date: July 2027

Dermatology

• Barrier Preparations Formulary

  (231 kb)

  Review date: Feb 2028
• Emollient Formulary

  (340 kb)

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

  (252 kb)

  Review date: Jul 2026
• Solar Keratosis - Primary Care Pathway

  (259 kb)

  Review date: July 2026
• Topical Tacrolimus for Facial Vitiligo

  (84 kb)

  Review date: Jan 2026

• Dermatology Shared Care Protocols
• Dermatology Patient Information Leaflets

Diabetes

• Blood Glucose and Ketone Testing - Frequency and Eligibility

  (213 kb)

  Review date: March 2026
• Blood Glucose Testing Meters Formulary - N&N ICB

  (422 kb)

  Review date: March 2026
• Diabetes - Type 2 Treatment Algorithm

  (1276 kb)

  Review date: Nov 2025
• Continuous Glucose Monitoring Devices - commissioning policy

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

  (196 kb)

  Review date: Dec 2025
• Continuous Glucose Monitoring Devices - device selection principals

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

  (627 kb)
• Hybrid Closed Loop - Commissioning Policy

  (276 kb)
• Hybrid Closed Loop - Educational Resources

  (755 kb)
• Hybrid Closed Loop FAQs for patients

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

  (152 kb)

  Review date: April 2027

Endocrine

• Cinacalcet Prescribing Information Sheet

  (134 kb)

  Review date: May 2026
• Liothyronine for Hypothyroidism Position Statement

  (79 kb)

  Review date: Mar 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

  (237 kb)

  Review date: July 2026

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

  (84 kb)

  Review date: Jul 2028
• Bariatric Surgery - Monitoring and Medication Post Surgery

  (271 kb)

  Review date: Sep 2025
• Constipation - Links to National Guidelines

  (92 kb)

  Review date: December 2026
• Gastroprotection (with PPI) for Patients on NSAID or Antiplatelet

  (207 kb)

  Review date: Jan 2028
• Omeprazole Liquid for Children - Review Algorithm

  (256 kb)

  Review date: Dec 2024
• 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

Haematology

• Anaemia- Ferric Maltol Treatment Algorithm

  (74 kb)

  Review date: Nov 2026
• Vitamin B12 Treatment Guideline

  (125 kb)

  Review date: July 2028

High Cost Drugs

• High Cost Drugs - Atopic Dermatitis treatment algorithm

  (158 kb)

  Review date: July 2026
• Biosimilar Position Statement

  (137 kb)

  Review date: March 2027
• High Cost Drugs - Psoriatic Arthritis treatment algorithm

  (157 kb)

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

  (138 kb)

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

  (156 kb)

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

  (164 kb)

  Review date: July 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

  (297 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

  (193 kb)

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

  (417 kb)

  Review date: May 2028
• Dementia - Donepezil Information Sheet

  (265 kb)

  Review date: Jan 2027
• Dementia - Galantamine Information Sheet

  (268 kb)

  Review date: Jan 2027
• Dementia - Memantine Information Sheet

  (198 kb)

  Review date: Jan 2027
• Dementia - Rivastigmine Information Sheet

  (276 kb)

  Review date: Jan 2027
• Lamotrigine Bipolar Disorder

  (212 kb)

  Review date: Nov 2026
• Lithium Prescribing Guideline

  (299 kb)

  Review date: November 2027
• Vortioxetine Information Sheet

  (147 kb)

  Review date: Jan 2026

• 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

  (234 kb)

  Review date: May 2026
• 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

  (260 kb)

  Review date: July 2026
• Modafinil Information Sheet

  (146 kb)

  Review date: July 2026
• Narcolepsy-Dexamfetamine Information Sheet

  (229 kb)

  Review date: July 2026
• Nitrazepam for the Treatment of Epilepsy in Children and Young People Information Sheet

  (163 kb)

  Review date: Jan 2027
• 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
• Restless Legs Treatment Algorithm

  (196 kb)

  Review date: Mar 2026

• 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

  (247 kb)

  Review date: May 2027
• Vitamin D Guideline for Children

  (261 kb)

  Review date: May 2027

Obstetrics and Gynaecology

• HRT Formulary Choices Summary

  (248 kb)

  Review date: Jun 2025
• 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

  (96 kb)

  Review date: December 2025
• Drospirenone Prescribing Information Sheet

  (240 kb)

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

  (26 kb)

  Review date: May 2025

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

Pain

• Overarching Pain Guidelines - Management of Chronic Pain in Adults

  (1067 kb)

  Review date: Sep 2025
• Cluster Headaches - Home Oxygen Pathway

  (221 kb)

  Review date: January 2026
• Neuropathic Pain Guideline

  (419 kb)

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

  (159 kb)

  Review date: Apr 2026
• Opioids for Non-Cancer Pain in Adults

  (112 kb)

  Review date: May 2028
• Adult Headache Pathway

  (201 kb)

  Review date: April 2026

Palliative Care

• End of Life Guidance

  (580 kb)

  Review date: December 2025
• Palliative Care Pocketbook

  (355 kb)

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

  (503 kb)

  Review date: Jul 2027

Prescribing and Prescription Governance

• Inappropriate Request - Template Letter

  (24 kb)

  Review date: Nov 2025
• 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)

  (212 kb)

  Review date: Dec 2025
• Prescribing and Supply of Unlicensed and Off-label Medication Policy

  (242 kb)

  Review date: Apr 2026

• Emergency supply of medication - NHS Nottingham and Nottinghamshire ICB

Renal

• Renal Function Calculation and Drug Dosing/Monitoring

  (189 kb)

  Review date: November 2026
• Sick Day Rules Guidance

  (165 kb)

  Review date: Nov 2025
• Sick Day Rules Patient Leaflet - Please print and complete for the patient to keep

  (178 kb)

  Review date: Nov 2025
• Clinical Pathway For The Use Of SGLT2 inhibitors In Chronic Kidney Disease(CKD) and Type 2 Diabetes(T2DM)

  (162 kb)

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

  (198 kb)

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

  (988 kb)

  Review date: November 2027

• Renal Shared Care Protocols

Respiratory

• Asthma in Children and Young People - DO NOT USE FOR CHILDREN 12 AND OVER

  (266 kb)

  Review date: Mar 2025
• Asthma in Adults and Children over 12 years old

  (584 kb)

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

  (84 kb)

  Review date: July 2028
• Bronchiectasis Self Management Plan

  (221 kb)

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

  (208 kb)

  Review date: Mar 2026
• COPD Guideline

  (551 kb)

  Review date: July 2027
• COPD Self Management Plan

  (141 kb)

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

  (237 kb)

  Review date: Sept 26

• 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

  (278 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

  (284 kb)

  Review date: May 2028
• Overactive Bladder Clinical Guidance

  (205 kb)

  Review date: Jan 2026

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

• Falls- Medicines and Falls Chart (medicines that may increase risk of falls)

  (642 kb)

  Review date: Jan 2026
• Fludrocortisone for Orthostatic Hypotension

  (313 kb)

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

  (215 kb)

  Review date: Aug 2026
• Gynaecomastia Guidelines

  (188 kb)

  Review date: Mar 2026
• Osteoporosis Guideline

  (533 kb)

  Review date: December 2027
• Biosimilar

  (164 kb)

  Review date: May 2026