Adrenaline crisis kits

·         Supply of adrenal crisis kits V1

Diabetes

·         NICE NG28 Type 2 diabetes in adults: management

·         NICE NG17 Type 1 diabetes in adults: diagnosis and management

·         NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management

·         Guidelines for Blood Glucose Monitoring in Adults 2024 (V1.1)

·         Lancet factsheet V4.1 (2025)

·         Needles for Pen Injectors factsheet V4 (2024)

·         Semaglutide (Ozempic) setting pre-set quantities in GP practice systems to prevent overprescribing

Sharps Bins disposal

Cornwall Council: sharps bins collections information or 0300 1234 141

Isles of Scilly Council: For advice and disposal arrangements please contact St Mary's Hospital on 01720 422392

Tirzepatide (Mounjaro): weight loss

This information aims to provide information relating to tirzepatide (Mounjaro) as it is released from NHSE and in line with local implementation plans.

Introduction

Tirzepatide (Mounjaro) is a weight loss drug that, up to now, has only been prescribed for people with type 2 diabetes.

NICE published guidance on 23 December 2024 recommending that tripeptide (Mounjaro) be considered a treatment option for managing overweight and obesity, alongside a reduced-calorie diet and increased physical activity.

Tirzepatide (Mounjaro) criteria

Initially, because of the impact on services, NICE agreed that NHS England should publish criteria for the priority cohorts for Tirzepatide (Mounjaro).

Those priority cohorts are:

The Qualifying Co-morbidities are as follows:

Over time, these cohorts will be expanded to include the full criteria for tirzepatide (Mounjaro) which are:

People over the age of 18 who have a body mass index (BMI) of 35 or over (or a BMI of 32.5 for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, as they are at a higher risk of medical problems at a lower BMI) and one of the above weight-related co-morbidities.

Weight loss injections are not suitable for patients who:

• Have previously had weight loss surgery.
• Are not engaging in NHS wrap-around care.

Please also see the product SmPC for a complete list of prescribing cautions and contraindications.

Wrap-around care

The NICE TA1026 mandates provision of wrap-around care alongside the prescribing of tirzepatide (Mounjaro). NHSE expects that this will incorporate nutritional and dietetic advice as a minimum and access to behavioural change components, as a mandatory requirement to access treatment.

Further information

BMA: Tirzepatide (Mounjaro) for weight management in General Practice

Private prescribing

Online purchase

The UK medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) warns against buying weight loss medicines without a prescription.

Hormone replacement therapy

Adapted from Drug Safety Update Sep 2007

HRT effectively relieves vasomotor symptoms. In most cases, 2 - 3 years’ therapy is sufficient, but some women may need longer - this judgement should be made on a case-by-case basis with regular attempts to discontinue. Symptoms may recur for a short time after stopping HRT.

For all women, the lowest effective dose should be used for the shortest time.

Information on the risks and benefits associated with HRT can be found in the BNF, Chapter 6.4.

Osteoporosis

HRT is effective for prevention and treatment of osteoporosis, but its beneficial effect on bone diminishes after stopping treatment.

Because of the risks associated with long-term use, HRT should be used for prevention of osteoporosis only in women who are unable to use other medicines that are authorised for this purpose, or have troublesome symptoms.

Maintenance of bone density will be achieved with all currently available regimes / doses (although not all oestrogen preparations are licensed for osteoporosis prophylaxis). Doses of 2 mg estradiol valerate, 2 mg micronised estradiol, 625 micrograms conjugated oestrogen, or 50 micrograms transdermal oestrogen will increase bone density in osteopaenic and osteoporotic women.

Hence before prescribing HRT:

• The decision to prescribe HRT should be based on a thorough evaluation of the potential benefits and potential risks of treatment
• Healthcare professionals should assess every woman’s overall risk, including cardiovascular risk, particularly in those older than 60 years who have increased baseline risk of serious adverse events
• Evidence for the risks of HRT in women who had premature menopause is limited. However, the baseline risk of adverse events in these younger women is low, and the balance of benefits and risks may be more favourable than in older women.