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

  (264 kb)

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

  (307 kb)

  Review date: May 2025
• Cows Milk Allergy Guidelines

  (434 kb)

  Review date: May 2025
• Urticaria & Angioedema Primary Care Pathway

  (366 kb)

  Review date: Jan 2026

Anticoagulants

• Anticoagulants in AF

  (909 kb)

  Review date: Jul 2026
• Direct Oral Anticoagulants for DVT and PE - Prescribing Information

  (384 kb)

  Review date: Nov 2024
• Enoxaparin Information Sheet

  (314 kb)

  Review date: Jan 2027

• Living with Anticoagulation - Warfarin
• Living with Anticoagulation - DOACs

Cardiovascular Resources

• Blood Pressure and Heart Rate Monitoring in Children

  (486 kb)

  Review date: July 2026
• 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
• Inclisiran Prescribing Information Sheet

  (106 kb)

  Review date: Apr 2026
• Midodrine Monitoring Guidance

  (256 kb)

  Review date: Jul 2025
• Hypertriglyceridaemia Guideline

  (203 kb)

  Review date: July 2027

Heart Failure:

• Chronic heart failure in adults: diagnosis and management - NICE guideline [NG106]
• Chronic heart failure in adults – NICE Quality standard [QS9]
• Heart Failure Clinical Knowledge Summaries: NICE CKS
• NICE is planning to update their guideline NG106 Chronic heart failure in adults: diagnosis and management (Sep 2018). The publication date of the update is still to be confirmed. See the guideline in development page for progress on the update.

Cardiovascular Shared Care Protocols

Cardiovascular Patient Information Leaflets for Amiodarone and Dronedarone. 

Continence and Stoma

• Stoma Ancillaries Items Formulary

  (192 kb)

  Review date: Jul 2025
• Nottingham & Nottinghamshire Continence Appliance Formulary

  (1068 kb)

  Review date: See individual sections

Dependence

• Alcohol Dependence Guidelines (Primary Care)

  (713 kb)

  Review date: Jul 2025
• Naltrexone Information Sheet

  (193 kb)

  Review date: Jul 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

  (596 kb)

  Review date: Jun 2024
• Emollient Formulary

  (230 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

  (221 kb)

  Review date: Jan 2025
• Blood Glucose Testing Meters Formulary - N&N ICB

  (424 kb)

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

  (627 kb)

  Review date: Nov 2025
• Freestyle Libre and Dexcom One Prescribing Criteria

  (196 kb)

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

  (258 kb)
• Continuous Glucose Monitoring Devices - device selection principals

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

  (669 kb)
• Hybrid Closed Loop Interim Position Statement

  (133 kb)
• Hybrid Closed Loop FAQs for patients

  (140 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

  (251 kb)

  Review date: Dec 2024
• Testosterone Information Sheet

  (237 kb)

  Review date: July 2026

Eye

• Ciclosporin Eye Drop Information Sheet

  (143 kb)

  Review date: Mar 2025
• Eye Lubricant Formulary

  (190 kb)

  Review date: Oct 2025
• Eye Lubricant Prescribing Advice

  (150 kb)

  Review date: Oct 2024

Gastroenterology

• Aminosalicylates in IBD in Adults - Information Sheet

  (269 kb)

  Review date: Jul 2025
• Anaemia in IBD Pathway

  (349 kb)

  Review date: Aug 20204
• 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

  (240 kb)

  Review date: Jul 2025
• Linaclotide Prescribing Information Sheet

  (109 kb)

  Review date: Dec 2024
• 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

• Inflammatory Bowel Disease shared care protocols
• Inflammatory Bowel Disease patient information leaflets

Haematology

• Anaemia- Ferric Maltol Treatment Algorithm

  (130 kb)

  Review date: Nov 2026
• Vitamin B12 Treatment Guideline

  (317 kb)

  Review date: Feb 2024

High Cost Drugs

• Biosimilar Position Statement

  (136 kb)
• High Cost Drugs - Ankylosing Spondylitis treatment algorithm

  (245 kb)

  Review date: Sept 2024
• High Cost Drugs - Atopic Dermatitis treatment algorithm

  (100 kb)

  Review date: Sept 2024
• High Cost Drugs - Crohns Disease treatment algorithm

  (267 kb)

  Review date: Apr 2024
• High Cost Drugs - Psoriatic Arthritis treatment algorithm

  (155 kb)

  Review date: Apr 2024
• High Cost Drugs - Psoriasis treatment algorithm

  (135 kb)

  Review date: Apr 2024
• High Cost Drugs - Rheumatoid Arthritis treatment algorithm

  (57 kb)

  Review date: Apr 2024
• High Cost Drugs - Ulcerative Colitis treatment algorithm

  (147 kb)

  Review date: Apr 2024

Mental Health Resources

• Agomelatine Prescribing Information Sheet

  (151 kb)

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

  (451 kb)

  Review date: Sep 2025
• Antipsychotics - Clozapine Information Sheet

  (293 kb)

  Review date: Sept 2027
• Antipsychotics Prescribing Guideline

  (529 kb)

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

  (287 kb)

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

  (129 kb)

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

  (181 kb)

  Review date: Mar 2025
• Daridorexant prescribing information sheet

  (98 kb)

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

  (426 kb)

  Review date: Oct 2024
• Dementia - Donepezil Information Sheet

  (238 kb)

  Review date: Jan 2027
• Dementia - Galantamine Information Sheet

  (250 kb)

  Review date: Jan 2027
• Dementia - Memantine Information Sheet

  (174 kb)

  Review date: Jan 2027
• Dementia - Rivastigmine Information Sheet

  (247 kb)

  Review date: Jan 2027
• Lamotrigine Bipolar Disorder

  (245 kb)

  Review date: Nov 2026
• Lithium Prescribing Guideline

  (355 kb)

  Review date: Oct 2024
• Vortioxetine Information Sheet

  (138 kb)

  Review date: Ian 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

• Adult Headache Pathway

  (260 kb)

  Review date: August 2027
• Buccal Midazolam Guideline for Patients under Paediatric Care

  (234 kb)

  Review date: May 2026
• Melatonin Use in Sleep Problems in Children

  (1009 kb)

  Review date: Aug 2024
• Monoamine-oxidase-B Inhibitors in Patients with Off Periods Without Dyskinesia

  (102 kb)

  Review date: Dec 2024
• Narcolepsy- Methylphenidate Information sheet

  (260 kb)

  Review date: July 2026
• Narcolepsy- Modafinil Information Sheet

  (126 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

  (259 kb)

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

  (250 kb)

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

  (441 kb)

  Review date: Sep 2026
• Infant Feeds - Premature Infants

  (259 kb)

  Review date: Jan 2027
• Lactose Intolerance Guideline

  (205 kb)

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

  (214 kb)

  Review date: Aug 2027
• Vitamin D Guideline for Adults

  (336 kb)

  Review date: May 2027
• Vitamin D Guideline for Children

  (345 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

  (288 kb)

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

  (108 kb)

  Review date: May 2025
• Drospirenone Prescribing Information Sheet

  (240 kb)

  Review date: March 2027
• Domperidone for lactation stimulation – Prescribing Information

  (145 kb)

  Review date: May 2025
• Domperidone for Lactation Stimulation - Template Letter

  (26 kb)

  Review date: May 2025

Pain

• Overarching Pain Guidelines - Management of Chronic Pain in Adults

  (1067 kb)

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

  (219 kb)

  Review date: Jul 2025
• Neuropathic Pain Guideline

  (438 kb)

  Review date: Sep 2024
• Opioid Deprescribing in Persistent Non-Cancer Pain

  (256 kb)

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

  (157 kb)

  Review date: Jun 2024
• Headache in Adults Guideline

  (265 kb)

  Review date: April 2026

Palliative Care

• End of Life Guidance

  (585 kb)

  Review date: May 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

• Retrospective Prescribing ICB Position Statement

  (182 kb)

  Review date: Apr 2025
• Inappropriate Request - Template Letter

  (24 kb)

  Review date: Nov 2025
• Out of Area Prescribing Requests

  (117 kb)

  Review date: Jul 2025
• Unlicensed "Specials" - Alternatives and Options for Prescribing (PrescQIPP)

  (212 kb)

  Review date: Mar 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 SGLT 2 inhibitors in Chronic Kidney Disease in Primary Care

  (204 kb)

  Review date: July 2026
• Finerenone For Treating Chronic Kidney Disease (CKD) In Type 2 Diabetes - Prescribing Information Sheet

  (198 kb)

  Review date: March 2027

• Renal Shared Care Protocols

Respiratory

• Asthma in Children and Young People

  (266 kb)

  Review date: Mar 2025
• Asthma in Adults

  (217 kb)

  Review date: February 2025
• Asthma Self Management Plan

  (271 kb)

  Review date: Jun 2025
• Bronchiectasis Self Management Plan

  (210 kb)

  Review date: Jun 2025
• COPD Emergency Supply Medicines – Prescribing Information

  (208 kb)

  Review date: Mar 2026
• COPD Guideline

  (540 kb)

  Review date: July 2027
• COPD Self Management Plan

  (149 kb)

  Review date: Jun 2025
• Guidance on (S)MART [(Single-inhaler) Maintenance and Reliever Therapy] in Asthma

  (244 kb)

  Review date: Apr 2026
• Colistimethate for Non-CF Bronchiectasis - Information sheet

  (237 kb)

  Review date: Sept 26

• COPD - Action Plan for Patients with Learning Difficulties
• Greener NHS - Respiratory

Transgender

• Information and Guidance on Prescribing in Transgender Health

  (244 kb)

  Review date: December 2024

• Transgender collaborative care protocol
• Feminising Hormone Treatment for Adults
• Masculinising Hormone Treatment for Adults

Urology

• Desmopressin (Noqdirna) Prescribing Information Sheet

  (237 kb)

  Review date: Sep 2025
• Male LUTS clinical guideline

  (205 kb)

  Review date: May 2025
• 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 

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

  (613 kb)

  Review date: Jul 2022
• Biosimilar FAQ's

  (164 kb)

  Review date: May 2026

• Antimicrobial Guidelines
• Antimicrobial Bulletins
• Palliative Care Stockist Scheme
• Covid
• Covid Vaccine
• Greener NHS