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Type 2 diabetes in line with NICE TA336. CKD treatment in line with NICE TA942. See local CKD pathway.

Guidance on Generic SGLT2i Prescribing in LLR

Dapagliflozin is First Line in LLR

Asthma: NOT RECOMMENDED IN ADULTS

50/25 – For children 4 years and over only when an aerosol device is required.

125/25 – For 12-17 year olds only when increased dose of ICS indicated and an aerosol device is required.

Must not be used for AIR or MART regimens

COPD: Not licensed

Conditional on prescriber being competent to select appropriate patients.

Fiasp (insulin aspart) FlexTouch 100units/ml solution for injection 3ml pre-filled pens have been out of stock since 31^st March 2024 and have subsequently been discontinued. Prescribers should not initiate patients on Fiasp FlexTouch 100units/ml pre-filled pens and should instead consider Fiasp Penfill cartridges where reusable pens are available as sufficient cartridges to support increased demand.

In UHL where access to reusuable pens is limited following SBAR should be followed: SBAR Fiasp®

Conditional on prescriber being trained to select appropriate patients
MUST BE PRESCRIBED BY BRAND NAME

Tresiba (insulin degludec) FlexTouch 100units/ml solution for injection 3ml pre-filled pens have been out of stock since 31^st July 2023 and have subsequently been discontinued. Prescribers should not initiate patients on Tresiba FlexTouch 100units/ml pre-filled pens and should instead consider Tresiba Penfill cartridges where reusable pens are available as sufficient cartridges to support increased demand. In the community, reusable pens are normally issued at same time as initial cartridge prescription.  UHL continue to have no supplies of the reusable pens so will need to follow the SBAR with respect to changing to higher strength flextouch for Tresiba.

In UHL where access to reusable pens is limited following SBAR should be followed Tresiba® Flextouch SBAR

Patients should not be initiated on any Levemir® product as it is being discontinued, with stock anticipated to last until 31st December 2026.

In primary care follow the circulated SBAR to identify, review and switch patients to an alternative insulin. A widespread switch should not be initiated and alternative insulins will need to be chosen on an individual patient basis.

First line short acting insulin in LLR

Clinicians should not initiate new patients on VIALS Humulin® S as they are being discontinued.

CARTRIDGES and DISPOSABLE KwikPens remain available (HumaPen® Savvio® reusable pen is compatible with cartridges)

Extracting insulin from pre-filled pens and cartridges is considered a NEVER event and should not occur in clinical practice

First Line Intermediate Acting Insulin in LLR

Clinicians should not initiate new patients on VIALS of Humulin® I as they are being discontinued.

CARTRIDGES and DISPOSABLE KwikPens remain available (HumaPen® Savvio® reusable pen is compatible with cartridges)

Extracting insulin from pre-filled pens and cartridges is considered a NEVER event and should not occur in clinical practice

For paediatric use only for patients who are proven intolerant to any excipients in other PPI formulations or weigh <3.5kg or have an NG tube <8fr.

For other patients please use Omeprazole MUPS

Rectal Use.

Use Cleen Ready-to-Use Enema as the preferred option due to lower cost.

Due to the risk of infection, enemas should not be used in patients on chemotherapy or neutropenic patients.

Conditional on prescriber being competent to select appropriate patients.

First choice GLP-1 RA for T2DM new starts where BMI < 35 in line with NICE NG28

First choice GLP-1 RA for T2DM new starts where BMI > 35 – SC Semaglutide (Ozempic) or SC Tirzepatide (Mounjaro) in line with NICE NG28

Sildenafil generic is first line choice due to lower cost.

500mg capsules are the preferred cost-effective preparation

For patients who have not responded to sildenafil.

10mg and 20mg for PRN dosing.

Approved for daily administration for individuals requiring more than 4 doses per month.

Do not prescribe 2.5mg OD dosing.

Higher cost than both tadalafil and sildenafil.

Third line choice after sildenafil and tadalafil where these products are appropriate to use.