Methotrexate Rheumatology Request Form(876 KB)
Date added: 17th Sep 2025
| Drug Name | Classification | Clinical Indication | Comments |
|---|---|---|---|
| Do not prescribe | |||
| TIRZEPATIDE (Mounjaro®) (UPDATED) | Red | Management of overweight and obesity |
September 2025: Tirzepatide for weight loss and obesity is currently restricted to prescribing within specialist weight management services. For further details, please refer to the LLR Position Statement Tirzepatide (Mounjaro®) for Obesity Management. Until an implementation plan is established, Tirzepatide should not be prescribed in primary care for this indication. |
| 30% SOLUBLE / 70% ISOPHANE INSULIN (Humulin® M3) (UPDATED) | Green | Diabetes Mellitus |
Clinicians should not initiate new patients on VIALS of Humulin® M3 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 |
| APOMORPHINE | Orange | Parkinson's disease |
|
| AZATHIOPRINE (UPDATED) | Orange | Dermatological disease | |
| AZATHIOPRINE (UPDATED) | Orange | Paediatric Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease) |
|
| AZATHIOPRINE | Orange | Rheumatological disease | |
| AZATHIOPRINE | Orange | Inflammatory Bowel Disease (Ulcerative Colitis, Crohn's Disease) & Autoimmune Hepatitis | |
| AZATHIOPRINE | Orange | Autoimmune neurological disorders |
Please see SCA for individual indications |
| BENRALIZUMAB (Fasenra®) (NEW) | Red | For treating relapsing or refractory eosinophilic granulomatosis with polyangiitis |
In line with NICE TA1096. |
| BENRALIZUMAB (Fasenra®) (NEW) | Red | Severe Eosinophilic Asthma |
In line with NICE TA565 |
| BETAMETHASONE 0.1% + NEOMYCIN 0.5% EYE DROPS (Betnesol N®) (UPDATED) | Yellow | Inflammatory Eye Disease |
Courses of treatment, including short courses less than 7 days should be recommended by the the specialist team. Extended courses must be recommended by the specialist team who continue to have clinical oversight. |
| BIPHASIC INSULIN LISPRO (Humalog® Mix25) (UPDATED) | Green | Diabetes Mellitus |
Clinicians should not initiate new patients on VIALS of Humalog® Mix25 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 |
| CANAGLIFLOZIN | Green | Type 2 diabetes |
Conditional on prescriber being competent to select appropriate patients. |
| CLOBETASONE BUTYRATE, NYSTATIN, & OXYTETRACYCLINE CALCIUM (Trimovate Cream®) (UPDATED) | Red | Indicated for inflammatory dermatoses with bacterial and /or candidal overgrowth. |
Combination product which includes a topical corticosteroid (moderately potent), antifungal and antibacterial components. Indicated for inflammatory dermatoses with bacterial and /or candidal overgrowth. Use restricted to:
|
| CLOBETASONE BUTYRATE, NYSTATIN, & OXYTETRACYCLINE CALCIUM (Trimovate Cream®) (NEW) | Yellow | Treatment of overgranulation in paediatric gastrostomy and jejunostomy stomas |
Supported for use in the treatment of overgranulation in paediatric gastrostomy and jejunostomy stomas in line with local guidelines. |
| COLISTIN (Colomycin ® and Promixin®) (UPDATED) | Yellow | Bronchiectasis |
Please see guide for more information. Must be prescribed by brand as the brands are not interchangeable. May 2025: Promixin is being discontinued, to use remaining stock for existing patients. Patients prescribed Promixin in primary care should be referred back to specialist team for review. |
| DAPAGLIFLOZIN (UPDATED) | Yellow | With insulin for treating Type 1 diabetes, historic patients only |
Now unlicensed due to commercial reasons
|
| DAPAGLIFLOZIN (UPDATED) | Green | CKD in adults |
In line with NICE TA775 See CKD pathway for more information |
| DAPAGLIFLOZIN (UPDATED) | Yellow | Chronic Heart failure with reduced ejection fraction and preserved ejection fraction |
In line with NICE TA679 and NICE TA902 |
| DAPAGLIFLOZIN (UPDATED) | Green | Type 2 diabetes |
Conditional on prescriber being competent to select appropriate patients |
| DAPAGLIFLOZIN (UPDATED) | Yellow | Type 2 diabetes |
Simple amber if GP does not feel competent to initiate. Use in line with NICE TA 288 |
| DESOGESTREL (Desorex® - 75) (UPDATED) | Green | Oral POP | |
| DEXAMETHASONE 0.1% + NEOMYCIN AND POLYMYXIN B SULPHATE (Maxitrol®) (UPDATED) | Yellow | Inflammatory Eye Disease |
Courses of treatment, including short courses less than 7 days should be recommended by the the specialist team. Extended courses must be recommended by the specialist team who continue to have clinical oversight. |
| DEXAMETHASONE 0.1% EYE DROPS (Maxidex®) (UPDATED) | Yellow | Inflammatory Eye Disease |
Courses of treatment, including short courses less than 7 days should be recommended by the the specialist team. Extended courses must be recommended by the specialist team who continue to have clinical oversight. |
| DONEPEZIL (UPDATED) | Yellow | Alzheimer's disease |
In line with NICE NG 97 If orodispersible formulation required prescribe Apozyl®. |
| DROSPIRENONE (Slynd®) (NEW) | Green | Oral POP |
Restricted to women with endometriosis and those who are unable to tolerate side effects as a result of 1st and 2nd generation progestogens
|
| 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. |
| EMPAGLIFLOZIN (Jardiance®) (UPDATED) | Yellow | Chronic heart failure with preserved or mildly reduced fraction and reduced ejection fraction |
In line with NICE TA929 and NICE TA773 |
| ERTUGLIFLOZIN (Steglatro®) | Yellow | Type 2 diabetes mellitus (for 18 years and over) as monotherapy or with metformin or with metformin and a dipeptidyl peptidase-4 inhibitor |
In line with NICE TA 572 and NICE TA 583 |
| ERTUGLIFLOZIN (Steglatro®) | Green | Type 2 diabetes mellitus (for 18 years and over) as monotherapy |
In line with NICE TA 572 |
| ETHINYLESTRADIOL & LEVONORGESTREL (TriRegol®) (NEW) | Green | Oral CHC |
Phasic preparation – where there is inadequate cycle control with monophasic preparations
|
| ETHINYLESTRADIOL /DESOGESTREL (Bimizza®- 20/150, Gedarel® 20/150, Gedarel® 30/150) (UPDATED) | Green | Oral CHC |
THIRD CHOICE Gedarel®: Specify strength when prescribing (two formulations available) |
| ETHINYLESTRADIOL /DROSPIRENONE (Yacella® - 30/3000, Eloine® - 20/3000) (UPDATED) | Green | Oral CHC (Drospirenone preparations ) |
Restricted to patients where CHC is being used in the treatment of Premenstrual symptoms, Polycystic Ovary Syndrome, Endometriosis and women with progestogenic side effects from 1st and 2nd generation preparations |
| ETHINYLESTRADIOL /ETONOGESTREL (NuvaRing® - 15/24hrs + 120/24hrs) (UPDATED) | Green | Combined Vaginal Ring |
Reserved as an option for patients with compliance issues with oral combined hormonal contraception |
| ETHINYLESTRADIOL /GESTODENE (Millinette® - 20/75, Millinette® - 30/75) (UPDATED) | Green | Oral CHC |
THIRD CHOICE Millinette® – Specify strength when prescribing (two formulations available) |
| ETHINYLESTRADIOL /LEVONORGESTREL (Levest® – 30/150) (UPDATED) | Green | Oral CHC |
FIRST CHOICE
|
| ETHINYLESTRADIOL /NORETHISTERONE (Brevinor® - 35/500, Norimin® - 35/1000) (UPDATED) | Green | Oral CHC |
SECOND CHOICE |
| ETHINYLESTRADIOL/ NORELGESTROMIN (Evra® - 33.9/24hrs + 203/24 hrs) (UPDATED) | Green | Combined transdermal patch |
Reserved as an option for patients with compliance issues with oral combined hormonal contraception |
| ETONOGESTREL (Nexplanon® - 68mg) (UPDATED) | Green | Parenteral progestogen-only contraception |
Subdermal Implant. Contraception for up to 3 years |
| FLUOROMETHOLONE 0.1% (FML®) (UPDATED) | Yellow |
Courses of treatment, including short courses less than 7 days should be recommended by the the specialist team. Extended courses must be recommended by the specialist team who continue to have clinical oversight |
|
| INSULIN DETEMIR (Levemir®) (UPDATED) | Green |
Patients should not be initiated on any Levemir® product as it is being discontinued. Any requests for new initiations should be referred to the clinician making the request. Prescriptions for stable patients should continue unchanged at this time National clinical guidance was published 14th August 2025; it is being reviewed by local specialists. A plan for managing LLR patients will be issued once agreed. Stock is expected to last until the end of 2026. |
|
| INSULIN ISOPHANE (Humulin I®) (UPDATED) | Green | Diabetes Mellitus |
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 |
| INSULIN ISOPHANE (Humulin S®) (UPDATED) | Green | Diabetes Mellitus |
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 |
| LEVONOREGESTREL INTRAUTERINE DELIVERY SYSTEM (Benilexa 52mg®) (UPDATED) | Green | Intra-uterine progestogen-only contraception/ heavy menstrual bleeding |
One-handed intrauterine system. |
| LEVONOREGESTREL INTRAUTERINE DELIVERY SYSTEM (Jaydess 13.5mg®) (NEW) | Green | Intra-uterine progestogen-only contraception |
Licensed as contraceptive for 3 years. Restricted to women who cannot tolerate higher doses. |
| LEVONOREGESTREL INTRAUTERINE DELIVERY SYSTEM (Kyleena 19.5mg®) (NEW) | Green | Intra-uterine progestogen-only contraception |
Licensed as contraceptive for 5 years. Restricted to women who cannot tolerate higher doses.
|
| LEVONOREGESTREL INTRAUTERINE DELIVERY SYSTEM (Levosert 52mg®) (UPDATED) | Green | Intra-uterine progestogen-only contraception/ heavy menstrual bleeding |
FIRST CHOICE The most cost effective levonorgestrel intrauterine system for contraception and heavy menstrual bleeding.
|
| LEVONOREGESTREL INTRAUTERINE DELIVERY SYSTEM (Mirena 52mg®) (UPDATED) | Green | Intra-uterine progestogen-only contraception |
For use in patients with risk factors for hyperplasia, and in patients with raised BMI. Can be used for protection from endometrial hyperplasia during oestrogen HRT.
|
| LEVONORGESTREL 1500 MICROGRAMS (Levonelle® 1500) (UPDATED) | Green | Emergency Contraception |
FIRST CHOICE Levonelle 1500® is available for supply on prescription. Levonelle One Step is available as a P medicine and via emergency contraception services. Should be administered as soon as possible after UPSI, preferably within 12 hours and no later than 72 hours after UPSI. |
| LINZAGOLIX (Yselty®) (NEW) | Yellow | For treating symptoms of endometriosis |
In line with NICE TA1067. |
| LINZAGOLIX (Yselty®) (NEW) | Yellow | For treating moderate to severe symptoms of uterine fibroids |
In line with NICE TA996. |
| MACROGOL ORAL POWDER, COMPOUND (UPDATED) | Green | Constipation - Osmotic Laxative |
Cost of brand varies according to setting. |
| MEDROXYPROGESTERONE ACETATE (Depo-Provera® - 150mg, Sayana Press® - 104mg) (UPDATED) | Green | Parenteral progestogen-only contraception |
Depo-Provera® – 150mg, administered every 12 weeks Sayana Press® – 104mg may be self-administered every 13 weeks if appropriate; lower dose potentially fewer side effects
|
| MERCAPTOPURINE (UPDATED) | Orange | Paediatric Inflammatory Bowel Disease (Ulcerative Colitis and Crohn's Disease) | |
| MESTRANOL /NORETHISTERONE (Norinyl-1® - 50/1000) (UPDATED) | Green | Oral CHC |
SECOND CHOICE |
| METHOTREXATE Oral (UPDATED) | Orange | Rheumatological disease |
Always prescribe oral Methotrexate in multiples of 2.5mg tablet strength. The 10mg tablets must NOT be prescribed or supplied. |
| METHOTREXATE Oral (UPDATED) | Orange | Dermatological disease |
Always prescribe oral Methotrexate in multiples of 2.5mg tablet strength. The 10mg tablets must NOT be prescribed or supplied |
| METHOTREXATE Oral (UPDATED) | Orange | Crohn's Disease |
Always prescribe oral Methotrexate in multiples of 2.5mg tablet strength. The 10mg tablets must NOT be prescribed or supplied |
| MIRIKIZUMAB (Omvoh®) (NEW) | Red | For previously treated moderately to severely active Crohn's disease |
In line with NICE TA1080 |
| MYCOPHENOLATE MOFETIL (UPDATED) | Orange | Autoimmune conditions |
Please see shared care agreement for individual indications |
| NEMOLIZUMAB (NEW) | Red | For treating moderate to severe atopic dermatitis in people 12 years and over |
In line with NICE TA1077 Funding from: 2/10/25 |
| NORETHISTERONE (Noriday® - 350) (UPDATED) | Green | Oral POP |
FIRST CHOICE
|
| NORGESTON (Norgeston® - 30) (UPDATED) | Green | Oral POP |
FIRST CHOICE
|
| PENTOXIFYLLINE, TOCOPHEROL, SODIUM CLODRONATE (Pentoclo) (NEW) | Do not prescribe | For Manibular osteoradionecrosis |
Not supported for use outside of clinical trials. |
| PORCINE INSULIN (Hypurin® Porcine 30/70 Mix) (UPDATED) | Green | Diabetes Mellitus |
Not recommended for new initiations, stable patients can continue. VIAL presentations ONLY of Hypurin® Porcine 30/70 Mix are being discontinued. Cartridge presentations remain available. The 3ml penfills (cartridges) can be used in the new Mypen2 reusable insulin pen device. The Mypen 2 will be available from the end of September 2025, await confirmation of availability before switching. Extracting insulin from pre-filled pens and cartridges is considered a NEVER event and should not occur in clinical practice. |
| PORCINE INSULIN (Hypurin® Porcine Isophane) (UPDATED) | Green | Diabetes Mellitus |
Not recommended for new initiations, stable patients can continue. VIAL presentations ONLY of Hypurin® Porcine Isophane are being discontinued. Cartridge presentations remain available. The 3ml penfills (cartridges) can be used in the new Mypen2 reusable insulin pen device. The Mypen 2 will be available from the end of September 2025, await confirmation of availability before switching. Extracting insulin from pre-filled pens and cartridges is considered a NEVER event and should not occur in clinical practice. |
| PORCINE INSULIN (Hypurin® Porcine Neutral) | Green | Diabetes Mellitus |
Not recommended for new initiations, stable patients can continue. VIAL presentations ONLY of Hypurin® Porcine Neutral are being discontinued. Cartridge presentations remain available. The 3ml penfills (cartridges) can be used in the new Mypen2 reusable insulin pen device. The Mypen 2 will be available from the end of September 2025, await confirmation of availability before switching. Extracting insulin from pre-filled pens and cartridges is considered a NEVER event and should not occur in clinical practice. |
| PREDNISOLONE 0.5% EYE DROPS (UPDATED) | Yellow | Inflammatory Eye Disease |
Used in preference to prednisolone acetate 1% for conditions in which less ocular penetration is required. Courses of treatment, including short courses less than 7 days should be recommended by the the specialist team. Extended courses must be recommended by the specialist team who continue to have clinical oversight. |
| PREDNISOLONE 1% EYE DROPS (UPDATED) | Yellow | Inflammatory Eye Disease |
Courses of treatment, including short courses less than 7 days should be recommended by the the specialist team. Extended courses must be recommended by the specialist team who continue to have clinical oversight. |
| SPARSENTAN (NEW) | Red | For treating primary IgA nephropathy |
In line with NICE TA1074 Funding from: 23/9/25 |
| SPESOLIMAB (NEW) | Red | For treating generalised pustular psoriasis flares |
In line with NICE TA1070 Funding from: 16/9/25 |
| ULIPRISTAL ACETATE (ellaOne®) (UPDATED) | Green | Emergency Contraception |
ellaOne® is available for supply on prescription, as a P medicine and via emergency contraception services Should be administered as soon as possible after UPSI, and no later than 5 days (120 hours) after UPSI. |
Other Updates on this Website
Recent documents from LLR APC and TAS
Methotrexate Dermatology Request Form(852 KB)
Date added: 17th Sep 2025
Methotrexate Adult Gastroenterology Request Form(852 KB)
Date added: 17th Sep 2025
Paediatric Mercaptopurine Shared Care Agreement(426 KB)
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LLR Position Statement: Tirzepatide (Mounjaro®) for Obesity Management(114 KB)
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Oral Nutritional Supplement (ONS) Replacement in Care Home – Training(2 MB)
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Oral Nutritional Supplement Replacement in Care Homes(777 KB)
Date added: 3rd Sep 2025
Unlicensed or off label use of medicines LMC chapter 12(104 KB)
Date added: 26th Aug 2025
Transportation of medicines LMC Chapter 8(78 KB)
Date added: 26th Aug 2025
Supply and ordering of medicines from pharmacies LMC chapter 5(140 KB)
Date added: 26th Aug 2025
Supply and Administration of Medicines by Midwives LMC Chapter 16(200 KB)
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Security and storage of medicines LMC Chapter 9(194 KB)
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Ratification-process-structure-of-the-Medicines-Code(207 KB)
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Procurement and Acquisition of Medicines LMC Chapter 3(127 KB)
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Prescribing Medicine LMC Chapter 2(507 KB)
Date added: 26th Aug 2025
Prescribing dispensing and administration of cytotoxic chemotherapy LMC Chapter 14(127 KB)
Date added: 26th Aug 2025
Prescribing and Administration of Medicines in Children LMC Chapter 13(313 KB)
Date added: 26th Aug 2025
Personal Use and Self Prescribing LMC Chapter 17(138 KB)
Date added: 26th Aug 2025
Medicines in operating theatres LMC Chapter 15(176 KB)
Date added: 26th Aug 2025
Medicines defect reporting LMC Chapter 10(121 KB)
Date added: 26th Aug 2025
Leicestershire Medicines Code UHL Policy(201 KB)
Date added: 26th Aug 2025
Complementary and Alternative Medicines LMC chapter 18(160 KB)
Date added: 26th Aug 2025
Clinical trials LMC Chapter 11(143 KB)
Date added: 26th Aug 2025
Administration of medicines for inpatients LMC chapter 6(186 KB)
Date added: 26th Aug 2025
LLRAPC Newsletter – July 2025(354 KB) - LMSG/LLR APC newsletters
Date added: 20th Aug 2025
LLR APC Meeting Minutes July 2025(412 KB) - LMSG/LLR APC minutes
Date added: 20th Aug 2025
Azathioprine (Peadiatric Gastroenterology)(425 KB)
Version 3.0 uploaded December 2024
Date added: 6th Dec 2024
Methotrexate Rheumatology/Dermatology/Gastroenterology SCA(591 KB) - Shared care agreement
Version 1 Uploaded December 2022/January 2023
Date added: 29th Dec 2022
Ciclosporin Dermatology Shared Care Agreement(638 KB) - Shared care agreement
Version 1 Uploaded December 2022/January 2023
Version 3 uploaded 05/06/2025
Date added: 29th Dec 2022
Shared Care Request Form(72 KB) - Guidelines
Secondary Care Clinician request to GP to take over Shared Care
Date added: 3rd Jun 2015
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