LLR SBAR for Primary Care – Levemir® (insulin detemir) FlexPen and Penfill Discontinuation(295 KB)
Date added: 8th Feb 2026
| Drug Name | Classification | Clinical Indication | Comments |
|---|---|---|---|
| AMPHOTERICIN LOZENGE (NEW) | Red | For resistant candida |
Unlicensed product so restricted to hospital |
| BALOXAVIR MARBOXIL (Xofluza®) (NEW) | Red | Treatment and post exposure prophylaxis of influenza as per UKHSA guidelines |
For Influenza as per UKHSA guidelines. On virology advice only |
| BUDESONIDE / FORMOTEROL (Symbicort 100/3 pMDI®) (NEW) | Green | Asthma |
– Restricted for use in children 12 to 17 years old with asthma in line with LLR guidelines when an aerosol device is required – Children 5-11 years old only under secondary / tertiary asthma care where this may be started as MART regimen with spacer under specialist supervision. This can be continued in primary care. COPD: Not licensed
|
| CALCIUM POLYSTYRENE SULPHONATE (Calcium Resonium®) (UPDATED) | Red |
Monitor serum-calcium as patients with chronic renal failure may experience a sudden rise in serum-calcium. |
|
| CAPTOPRIL (NEW) | Red | For Acute Scleroderma renal crisis when haemodynamically unstable | |
| Captopril | Red | Acute Scleroderma renal crisis - in patient management | |
| DENOSUMAB (Jubereq®) (NEW) | Orange | Prevention of skeletal related events in adults with bone metastases from solid tumours other than prostate |
Biosimilar of denosumab; preferred first-line option in LLR for prevention of skeletal related events in adults with bone metastases from solid tumours other than prostate (120mg vial). |
| DENOSUMAB (Ponlimisi®) (NEW) | Orange | Osteoporosis |
Biosimilar of denosumab; preferred first-line option in LLR for osteoporosis (60mg PFS).
|
| DENOSUMAB (Prolia®) (UPDATED) | Orange | Osteoporosis |
Prolia® is the Reference (originator) product In LLR Ponlimsi® 60mg PFS (denosumab biosimilar) is the First line choice for osteoporosis instead of Prolia® Prolia® remains available for patients intolerant to biosimilar alternatives. |
| DENOSUMAB (Xgeva®) (UPDATED) | Orange | Prevention of skeletal related events in adults with bone metastases from solid tumours other than prostate |
Xgeva® is the Reference (originator) product. In LLR, Jubereq® 120 mg vial (denosumab biosimilar) is the preferred first-line option for prevention of skeletal related events in adults with bone metastases from solid tumours other than prostate; Xgeva® is used when a PFS is required. Xgeva® remains available for patients intolerant to biosimilar alternatives. |
| Dexcom ONE® and Dexcom ONE+® (UPDATED) | Yellow | Diabetes Continuous glucose monitoring (CGM) |
Dexcom ONE® and Dexcom ONE+ ® are approved for use in Leicester, Leicestershire and Rutland for diabetes glucose monitoring where a patient meets the criteria detailed in the LLR APC position statement. Dexcom ONE® will be discontinued on 31st March 2026 and therefore all patients using this device should be switched over to the updated Dexcom ONE+. All new patients must be started on Dexcom ONE+ |
| EMPAGLIFLOZIN (UPDATED) | Green | Type 2 diabetes & Chronic Kidney Disease |
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 |
| FLUTICASONE PROPIONATE / SALMETEROL (Seretide Evohaler®) (UPDATED) | Green | Asthma |
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 |
| Freestyle Libre 2 Plus® (UPDATED) | Yellow | Diabetes Continuous glucose monitoring (CGM) |
Freestyle Libre 2 Plus® is approved for use in LLR for diabetes glucose monitoring where a patient meets the criteria detailed in the LLR APC position statement.
|
| HYDROXYCARBAMIDE (UPDATED) | Red | Myeloproliferative disorders, sickle cell anaemia |
Hydroxycarbamide Prescribing Update and Retirement of Shared Care Agreement (SCA) |
| INHALED LEVODOPA (Inbrija®) (NEW) | Yellow | For Intermittent treatment of episodic motor fluctuations (OFF episodes) in adult patients with Parkinson’s disease (PD) treated with a levodopa/dopa-decarboxylase inhibitor |
To be used in patients who otherwise would progress to apomorphine First prescription to be supplied by specialist |
| INSULIN DETEMIR (Levemir®) (UPDATED) | Green |
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. |
|
| INSULIN HUMAN SOLUBLE (Humulin S®) (UPDATED) | Green | Diabetes Mellitus |
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 |
| INSULIN ISOPHANE (Humulin I®) (UPDATED) | Green | Diabetes Mellitus |
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 |
| NALTREXONE (UPDATED) | Yellow | For use in opioid dependency |
To be initiated by specialists for maintenance treatment to help prevent relapse in opioid dependence. |
| OMEPRAZOLE DISPERSIBLE (Losec MUPS) (NEW) | Green |
For use in paediatrics only |
|
| OMEPRAZOLE LIQUID (UPDATED) | Green |
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 |
|
| PHOSPHATE ENEMA (UPDATED) | Green | Constipation or Bowel Evacuation |
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.
|
| SODIUM BICARBONATE (UPDATED) | Green |
500mg capsules are the preferred cost-effective preparation |
|
| SODIUM POLYSTYRENE SULPHONATE (Resonium A®) (UPDATED) | Red | ||
| SODIUM ZIRCONIUM CYCLOSILICATE (Lokelma®) (UPDATED) | Red | Acute hyperkalaemia and Chronic hyperkalaemia in Heart Failure |
FIRST CHOICE Treatment of acute hyperkalaemia, see local ED pathway. Chronic hyperkalaemia within heart failure. Use in line with NICE TA 599 |
| STIRIPENTOL (UPDATED) | Orange | For the treatment of refractory generalised tonic-clonic seizures in patients with severe myoclonic epilepsy in infancy (Dravet syndrome). Treatment should be continued into adulthood if efficacy is observed. |
Orange for NEW Patients (Historic patients to carry on with current arrangements) |
| SULFASALAZINE | Orange | Rheumatological disease |
Other Updates on this Website
Recent documents from LLR APC and TAS
Management of Asthma in Children and Young People aged 12-17 years(612 KB)
Date added: 7th Feb 2026
Management of Asthma in Children aged 5-11 years(573 KB)
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TAS Minutes 23rd December 2025(288 KB) - TAS
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TAS Minutes 28th October 2025(251 KB) - TAS
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TAS Minutes 24th June 2025(255 KB) - TAS
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TAS Minutes 27th May 2025(231 KB) - TAS
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TAS Minutes 22nd April 2025(236 KB) - TAS
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LLR APC Meeting Minutes December 2025(354 KB) - LMSG/LLR APC minutes
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Denosumab Osteoporosis Shared Care Request Form National Format(329 KB) - Shared care agreement
Date added: 29th Dec 2022
Chronic Kidney Disease (CKD) Pathway(374 KB) - Guidelines
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SCA: Denosumab for Osteoporosis(297 KB) - Shared care agreement
Date added: 15th Nov 2019
DOAC for Non-valvular Atrial Fibrillation(464 KB) - Guidelines
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Malnutrition in Adults in Primary Care(423 KB) - Guidelines
Date added: 14th Nov 2017
About the Leicester, Leicestershire and Rutland Area Prescribing Committee
In common with other local health communities, the Leicester, Leicestershire and Rutland Area Prescribing Committee (LLR APC) acknowledges the benefits of having a Leicestershire Health Community-wide strategy for the prescribing of specialist medicines and the managed entry of new drugs and related technologies.
Leicestershire Health Community comprises the Leicester, Leicestershire and Rutland Integrated Care Board, University Hospitals of Leicester (UHL) NHS Trust and Leicestershire Partnership NHS Trust (LPT), amongst which there is a total consensus on the need for this strategy, and the LLR APC has been in place since 2005. Learn more