NICE Guidelines

What changed:

• August 2026: NICE updated its recommendations on treating self-limited epilepsy with centrotemporal spikes, following the UK licensing of sulthiame in January 2025. Sulthiame is no longer flagged as unlicensed in the guideline. Treatment remains led by tertiary paediatric neurology.

What changed:

• April 2026: Reviewed evidence for referral for ovarian cancer, endometrial cancer and non-site-specific weight loss. New and updated recommendations on ovarian cancer age and serum CA125 thresholds (recommendations 1.5.6 to 1.5.9, and 1.5.11), endometrial cancer (recommendations 1.5.12, 1.5.14 and 1.5.15), and non-site-specific weight loss (recommendation 1.13.2).
• January 2026: Removed an incorrect recommendation on blood tests for myeloma.
• May 2025: Amended recommendations 1.2.1 and 1.2.7: now recommends a suspected cancer pathway referral (rather than urgent direct access endoscopy) for people with symptoms indicating a 3% or more probability of oesophageal or stomach cancer.
• April 2025: Amended blood test recommendations for myeloma in response to NHS England National Cancer Programme reviews on earlier diagnosis. A further update covering colorectal, lung and other cancers is expected March 2026.

What changed:

• April 2026: Amended advice on when to seek help for vaginal bleeding while taking systemic HRT. Vaginal bleeding is recognised as a common side effect within the first 6 months of starting systemic HRT or within 3 months of changing the dose or preparation. Advise prompt medical help if unscheduled vaginal bleeding occurs beyond these timeframes. Acknowledges limited evidence for unscheduled bleeding on sequential or continuous HRT and signposts to the British Menopause Society 2024 guidance. Aligns with the parallel April 2026 update to NG12 on endometrial cancer referral.

What changed:

• March 2026 (new guideline replacing CG156): Major update reflecting a transition from generic treatment pathways to individualised, diagnosis-driven fertility care.
• Endometriosis recognised as a distinct fertility entity requiring tailored management.
• NICE advises against routine use of IVF add-ons such as endometrial scratching and receptivity testing without robust evidence.
• Expanded guidance supports fertility preservation for individuals undergoing treatments that may impair reproductive potential.
• Updated alignment with cervical screening recommendations to avoid delays in fertility treatment.
• Updated screening recommendations for Chlamydia trachomatis before uterine instrumentation.

What changed:

• February 2026: Major update, described by NICE as the 'biggest shake-up in type 2 diabetes care in a decade'. The key change is a shift from automatically starting everyone on metformin alone to personalised treatment plans that aim to prevent cardiovascular and renal complications, not just control blood sugar.
• SGLT-2 inhibitors move from second-choice to first-choice treatment: SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin) should now be offered alongside metformin as initial treatment for most adults with type 2 diabetes. Medicines should be introduced stepwise: start metformin first to check tolerability, then add the SGLT-2 inhibitor as soon as tolerability is confirmed. For patients who cannot tolerate metformin, start with an SGLT-2 inhibitor alone.
• Expanded access to GLP-1 receptor agonists and tirzepatide: Around 810,000 more people could benefit. GLP-1 receptor agonists (semaglutide, dulaglutide, liraglutide) and tirzepatide are now recommended for specific groups as part of initial treatment. Key groups: adults with established atherosclerotic CVD (triple therapy including subcutaneous semaglutide up to 1 mg weekly); adults with early-onset type 2 diabetes (diagnosed before age 40); adults living with obesity; adults with CKD (tailored to eGFR); adults with heart failure; adults with frailty or multiple health conditions.
• Additional changes: HbA1c target recommendations now refer to an 'initial medication regimen' rather than a 'single drug'. Endorsement of biosimilar insulin products. Expanded access to intermittently scanned CGM for adults on insulin with recurrent hypoglycaemia. Management of periodontitis incorporated into annual diabetes reviews. Links added to the NHS Type 2 Diabetes Path to Remission Programme.
• Cost impact: Generic dapagliflozin now available, with an estimated cumulative NHS savings of £560 million across 2025/26 and 2026/27. NICE analysis suggests the earlier introduction of SGLT-2 inhibitors could prevent approximately 17,000 deaths over 3 years by reducing heart attacks, strokes and kidney complications.
• Equity note: NICE analysis of nearly 590,000 anonymised records found SGLT-2 inhibitors are currently under-prescribed to women, older people, and Black or Black British individuals.

What changed:

• New recommendation added: Clinicians should now offer healthy living advice to patients with raised blood pressure who have not yet been formally diagnosed with hypertension. This formalises a proactive, pre-diagnostic conversation within routine practice.
• NICE has noted it is actively monitoring emerging evidence on antihypertensive drug response across different ethnic groups, and will update the guideline if that evidence warrants it.
• No changes to treatment or monitoring recommendations at this stage.

What changed:

• January 2026: Amended recommendations to clarify that height-to-weight ratios should only be used to classify the degree of central adiposity in children and young people aged 5 years and over.
• February 2025: changed 'weight-loss' to 'weight-management' medicines; March 2025: added NHS BMI/waist-to-height ratio calculator links; April 2025: changed 'UKVRN registered nutritionist' to 'registered nutritionist'.
• January 2025 (new guideline): Major consolidation with new evidence-reviewed recommendations on prevention in schools/nurseries, general principles of care, identification/assessment/referral, behavioural interventions, dietary advice, advice for ethnic minority backgrounds, multidisciplinary teams for children, and raising awareness of interventions. Emphasis on respectful, non-judgemental, person-centred care.

What changed:

• November 2025 (new guideline): Split from NG51 into three standalone guidelines. Key new recommendations include: initial IV fluid bolus of 250 ml over 10–15 minutes (previously 500 ml); guidance on peripheral vasopressor use; updated approach to finding and controlling the source of infection. Uses NEWS2 within clinical context for risk evaluation.

What changed:

• November 2025 (new guideline): Split from NG51 into a dedicated paediatric sepsis guideline covering recognition, early assessment, initial treatment, and escalation of care specific to children and young people. NICE plans to review the use of the national paediatric early warning score (PEWS) for future inclusion.

What changed:

• November 2025 (new guideline): Split from NG51 into a dedicated guideline for pregnancy and the postpartum period. Covers recognition, early assessment, initial treatment and education. NICE plans to review the use of the modified early obstetric warning score (MEOWS) for future inclusion.

What changed:

• September 2025: Reviewed evidence on treating and monitoring heart failure with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF). Key practice changes include: new recommendations for HFmrEF and HFpEF (previously no specific guidance); amended HFrEF recommendations on pharmacological treatment.
• October 2025: amended rationale for rec 1.7.10 to clarify ECG before beta-blocker prescribing.
• December 2025: amended rationale for rec 1.7.2 to clarify advice on ARNI prescribing by primary care.

What changed:

• September 2025 (new guideline): Amalgamates and replaces NICE antimicrobial prescribing guidelines on community-acquired pneumonia (NG138) and hospital-acquired pneumonia (NG139), both from 2019. Important practice changes: antibiotic course length reduced from 5 to 3 days for babies/children aged 3 months to 11 years with non-severe community-acquired pneumonia without complications; new recommendations on corticosteroids for adults in hospital with high-severity community-acquired pneumonia.
• Minor change November 2025: updated sepsis links to new NG253/254/255.

What changed:

• September 2025: Removed the section on clinical diagnosis of community-acquired pneumonia in primary care (this content is now covered by the new NG250 pneumonia guideline).

What changed:

• April 2025 (new guideline): Updates and replaces CG161 (2013). Key changes: scope expanded to include people aged 50–64 with conditions increasing fall risk (e.g. arthritis, dementia, diabetes, Parkinson's, stroke, learning disability). Recommends against using falls risk prediction tools (evidence shows insufficient accuracy when used alone). Emphasises opportunistic questioning about falls at routine appointments. New recommendations on comprehensive falls assessment, home hazard assessment using validated tools, and evidence-based exercise programmes. Applies across community, hospital, and care home settings.

What changed:

• January 2025 (safety update): Amended recommendations on valproate and topiramate in line with MHRA safety guidance. Key changes: valproate must not be started for the first time in anyone (male or female) under 55 unless two specialists independently confirm no other effective/tolerated treatment exists; boys and men advised to use effective contraception throughout valproate treatment and for 3 months after stopping; topiramate must not be used in women/girls of childbearing potential unless Pregnancy Prevention Programme conditions are met.
• Minor change November 2025: added links to relevant technology appraisals in childhood-onset epilepsies section (no change in clinical content).

What changed:

• January 2025 (new guideline): First NICE guideline on gambling-related harms. Recommendations for healthcare professionals on recognising signs, screening at-risk populations, and referring for specialist support. Includes guidance on opportunistic identification in primary care settings.

What changed:

• January 2025 (new guideline): Consolidates and updates NICE's previous public health guidelines on maternal and child nutrition. Should be read alongside NG246 (obesity). Covers folic acid and vitamin D supplementation, breastfeeding support, and introduction of complementary foods.

What changed:

• April 2026 (new guidance, early-use assessment): ArtiQ.Spiro recommended for use in GP surgeries and community diagnostic centres during an evidence generation period.
• Evidence includes a UK-based randomised controlled trial in primary care reviewed by primary care healthcare professionals.
• Four other technologies — EasyOne Connect, GoSpiro, LungHealth and MIR Spiro — require more research before they can be recommended for NHS use.
• The guidance specifies that these technologies should support, not replace, clinical judgement.

What changed:

• February 2026 (new guidance): CardioMEMS HF System can be used as an option for remote monitoring of NYHA class 3 chronic heart failure in adults at risk of hospitalisation. Evidence from economic modelling shows CardioMEMS is likely to be cost effective. More research is needed on the Cordella system before it can be funded by the NHS.

What changed:

• January 2026 (new guidance, early value assessment): Eight digital technologies recommended for use in the NHS during a 3-year evidence generation period. Clinical trial evidence is limited but suggests these technologies improve physical function and reduce pain and stiffness. They may also slow disease progression.

What changed:

• January 2026 (new guidance, early value assessment): Overcoming Bulimia Online recommended for use in the NHS during a 2-year evidence generation period, alongside usual waiting list care. It should only be offered after an initial assessment in primary care or by specialist eating disorder services. Evidence showed fewer binge-eating episodes and reduced symptom severity compared with those on waiting lists. Digital CBTe and Worth Warrior require more evidence.

What changed:

• December 2025 (new guidance, early value assessment): Seven digital technologies conditionally recommended for NHS use during a 3-year evidence generation period: Activate Your Heart, D REACH-HF, Digital Heart Manual, Gro Health HeartBuddy, KiActiv, myHeart, and Pumping Marvellous Cardiac Rehab Platform. Five additional platforms require more research and should only be used in research settings.

What changed:

• September 2025 update: Six technologies can be used in the NHS during a 3-year evidence generation period: Clinitouch, COPDhub, COPDPredict, Luscii, myCOPD, and one other. Two technologies were removed from recommendations because they are no longer available in the UK. COPD readmission rates remain high (23.9% within 30 days of discharge), highlighting the importance of effective self-management.

What changed:

• July 2025 (new guidance, early value assessment): Two technologies recommended: Limbic Access (an AI chatbot currently used by about 40% of NHS Talking Therapies services) and Wysa Digital Referral Assistant. A third technology, Censeo Digital, was removed after the MHRA issued a Field Safety Notice in January 2025 and the company confirmed it had left the UK market.

What changed:

• May 2025 (new guidance, early value assessment): ORBIT recommended for use alongside standard care in the NHS during a 3-year evidence generation period for children and young people aged 9–17 with chronic tic disorders and Tourette syndrome. Clinical evidence suggests ORBIT may reduce tic severity and improve everyday functioning. Neupulse could not be recommended in the final guidance because it does not yet have appropriate regulatory approval (CE/UKCA marking expected in 2026).

What changed:

• May 2025 (new guidance, early value assessment): DERM approved for use within NHS teledermatology services during a 3-year evidence generation period. Important caveats: evidence is mostly from people with white skin; a healthcare professional review is required for people with black or brown skin; regular monitoring of DERM's accuracy is mandatory; a national governance framework is needed for local oversight.

What changed:

• April 2025 (new guidance, late-stage assessment): The clinical evidence on different slide sheet features is limited and of poor quality. Key findings: washable slide sheets may save money compared with disposable or single-patient-use sheets, but only if an effective laundry system is in place. Slide sheets that remain under the person (in situ) may save money and have benefits for both the carer and patient when used for longer periods in the community.

What changed:

• November 2025 (new quality standard): Aligned with the new NG253 sepsis guideline.

What changed:

• October 2025: Updated quality standard aligned with current clinical guideline recommendations.

What changed:

• September 2025: Updated to reflect the major NG106 overhaul, including updated quality statements on pharmacological treatment.

What changed:

• September 2025: Updated to align with NG250, reflecting changes to antibiotic duration and new corticosteroid recommendations.

What changed:

• August 2025 (new quality standard): Aligned with NG246. Sets priority areas for person-centred approaches, access to behavioural interventions, and pharmacological treatment pathways.

What changed:

• July 2025: Updated quality standard on CVD risk assessment and management.

What changed:

• April 2025: Updated to reflect NG249. Includes quality statements on identifying people at risk, multifactorial assessment, and falls prevention exercise programmes.

What changed:

• December 2023 (published): Aligned with NG217. Note: published before the January 2025 valproate/topiramate safety update to the parent guideline.

What changed:

• October 2023 (published): Aligned with NG237. Includes statements on antibiotic prescribing and point-of-care CRP testing.

What changed:

• August 2026 (new technology appraisal): Finerenone can be used, within its marketing authorisation, as an option to treat symptomatic chronic heart failure with preserved or mildly reduced ejection fraction in adults. NHS England must fund it within 90 days of publication. The funding deadline is 3 November 2026.

What changed:

• July 2026 (final draft guidance): NICE recommends finerenone within its marketing authorisation for this indication, based on trial evidence showing a reduced risk of heart failure events requiring unplanned hospital treatment compared with placebo. Up to 280,000 people in England could be eligible. This is final draft guidance, not published final guidance. Final guidance is expected August 2026, at which point this entry will be updated with the TA number.

What changed:

• 30 June 2026 (new appraisal): Atogepant recommended for acute migraine treatment, evaluated through NICE's cost-comparison process against rimegepant, the usual acute treatment at this point in the pathway.
• Atogepant has not been directly compared with rimegepant in a clinical trial. An indirect comparison suggests similar pain reduction at 2 hours, though the result is uncertain. Clinical expert feedback supports using the two interchangeably, given their similar mechanism and administration.
• NICE advises prescribers to use whichever of atogepant and rimegepant is least expensive, taking account of administration costs, dosage and commercial arrangements.
• Atogepant must be funded in England within 30 days of publication, faster than the usual 90-day window because of the cost-comparison route. In Wales, funding is required within 60 days of the first publication of the final draft guidance.

What changed:

• 24 June 2026: Administrative update only. Recommendation 1.1 and the pricing sections were revised to remove reference to the company's commercial arrangement and update the list price to £45.36 per 28-pack, excluding VAT. The clinical eligibility criteria are unchanged since the original recommendation in April 2021.

What changed:

• 24 June 2026 (new appraisal): Seladelpar recommended as a second-line option after UDCA, alongside the existing options of obeticholic acid and elafibranor. The committee noted seladelpar may be of particular benefit for people with pruritus, since obeticholic acid carries a risk of worsening itch.
• The recommendation is based on the RESPONSE trial of 193 people with an inadequate response to, or intolerance of, UDCA. At 12 months, 61.7% of people taking seladelpar had a composite biochemical response (improved liver enzymes), compared with 20% taking placebo, and pruritus scores improved significantly more with seladelpar than placebo.
• Seladelpar has not been directly compared with obeticholic acid or elafibranor in a clinical trial. Indirect comparisons suggest it may reduce itch more than obeticholic acid, though comparative effectiveness against elafibranor remains uncertain.
• Seladelpar can only be used if the company provides it under the agreed commercial arrangement. It must be funded in England within 90 days of publication.

What changed:

• June 2026 (new appraisal): Mepolizumab recommended as an add-on to triple therapy for adults with uncontrolled COPD and blood eosinophils of at least 300 cells per microlitre (0.3 × 10⁹/litre), who have had at least one severe or two or more moderate exacerbations in the past year.
• The recommendation is based on the MATINEE trial (804 patients), which showed mepolizumab reduced the annual rate of moderate or severe exacerbations by around 21% compared with placebo in this eosinophilic group.
• Treatment is specialist-initiated and reviewed at 12 months, continuing only if there is a clinically meaningful reduction in exacerbations.
• A commercial arrangement is in place. NHS England is required to make mepolizumab available to eligible patients within 90 days of publication.
• Primary care relevance sits in the referral pathway: identify patients who keep exacerbating despite triple therapy and have a raised eosinophil count, and refer for specialist assessment.

What changed:

• May 2026 (new appraisal): Semaglutide 2.4 mg subcutaneous injection recommended weekly alongside a reduced-calorie diet and increased physical activity. Around 1.2 million UK adults are expected to be eligible.
• The recommendation is based on the SELECT trial of over 17,000 patients with cardiovascular disease and overweight or obesity, which showed semaglutide reduced the risk of major adverse cardiovascular events compared with placebo.
• NICE noted that cardiovascular benefits were seen early in the trial, before substantial weight loss occurred, suggesting effects beyond weight reduction.
• A commercial access agreement is in place. NHS integrated care boards in England are required to make semaglutide available to eligible patients within 90 days of publication. In Wales, the requirement is 60 days.
• This is a primary care relevant prescribing decision, with implications for cardiovascular secondary prevention pathways.

What changed:

• March 2026 (new appraisal): Fezolinetant 45 mg once daily recommended for women with moderate to severe vasomotor symptoms caused by menopause when HRT is unsuitable.
• First neurokinin-targeted therapy recommended by NICE. Around 500,000 women in England are expected to be eligible.
• Fezolinetant is not recommended for patients with current breast cancer, other oestrogen-dependent cancers, or liver disease. MHRA guidance on monitoring for liver injury should be reviewed before initiation.
• Fezolinetant treats vasomotor symptoms only and has not been compared head-to-head with HRT in clinical trials. Other menopausal symptoms (vaginal dryness, mood changes, joint pain) are not addressed by this treatment.

What changed:

• April 2026 (partial review of TA599): Sodium zirconium cyclosilicate recommended as an option for treating hyperkalaemia in adults only if used: in emergency care for acute life-threatening hyperkalaemia alongside standard care; or for persistent hyperkalaemia in people with CKD stage 3b to 5 or heart failure who have a confirmed serum potassium level of at least 5.5 mmol/litre and who, because of hyperkalaemia, are not taking an optimised dosage of a RAAS inhibitor. The key change from TA599 is the lowering of the serum potassium threshold from 6.0 mmol/litre to 5.5 mmol/litre, broadening the eligible population. Stop sodium zirconium cyclosilicate if RAAS inhibitors are no longer suitable.