Medicines identified as low value for prescribing in NHS Wales

The All Wales Medicines Strategy Group (AWMSG) endorsed low value for prescribing guidance provides advice ‎to prescribers and health boards in Wales to reduce the use of medicines that should not be routinely prescribed as either more cost‑effective alternatives exist (efficiency domain), evidence for the medicine’s clinical effectiveness is limited (efficiency domain), or the medicine may possibly pose a risk of harm to patients (safety domain).

This work was incorporated within the AWMSG endorsed Value-based Prescribing programme in 2022 which aims to deliver meaningful change in the use of medicines and resources for patients within Wales. A task and finish group, with representation from all health boards, reviewed the previous recommendations. The background information for each recommendation was reviewed and where relevant updated. For some medicines, the task and finish group felt that a more in-depth literature review needed to be conducted. These are included as appendices within the paper.  

Following public consultation and subsequent discussion by the All Wales Prescribing Advisory Group (AWPAG) and also by AWMSG, low value for prescribing medicines within the Medicines identified as low value for prescribing in NHS Wales have been grouped according to the following determinations:

• Low value for prescribing medicines to be actively monitored within the safety domain – co‑proxamol, chloral hydrate, minocycline, and paracetamol/tramadol combination products.
• Low value for prescribing medicines to be actively monitored within the efficiency domain – oxycodone/naloxone combination products, perindopril arginine, rubefacients, probiotics, ascorbic acid, alimemazine, blood glucose testing strips, liothyronine including desiccated thyroid extracts (e.g. Armour Thyroid), and omega-3 fatty acid compounds.   
• Low value for prescribing medicines to no longer be actively monitored – tadalafil, aliskiren, ketovite, selenium, silk garments and doxazosin modified release tablets.
• Low value for prescribing medicines to be temporarily removed from the active recommendations while further work relating to the implementation of the recommendations is considered – lidocaine 5% plasters.

Medicines removed from the active recommendation list are still considered to be of low value and data for their use will continue to be available for monitoring purposes. Should usage start to increase, their reintroduction to the active monitoring list will be considered.  

A new dashboard hosted within the Server for Prescribing Information Reporting and Analysis (SPIRA), accessible to all users who are on the NHS Wales network, provides more detailed analysis for the usage of medicines identified within the low value for prescribing guidance.

Published: July 2026

Equality and Health Impact Assessment (EqHIA) form

Medicines identified as low value for prescribing in NHS Wales - EqHIA

Paper 1 - Retired July 2026

Five medicines/medicine groups were identified for the purposes of this document: co-proxamol, lidocaine plasters, tadalafil once daily preparations, liothyronine and doxazosin modified release tablets.

(Published October 2017 - Retired July 2026)

Paper 2 - Retired July 2026

Four medicines/medicine groups were identified for the purposes of this document: omega-3 fatty acid compounds, oxycodone and naloxone combination product, paracetamol and tramadol combination product and perindopril arginine.

(Published December 2018 - Retired July 2026)

Paper 3 - Retired July 2026

Nine medicines/medicine groups were identified for the purposes of this document:

• Medicines of low clinical effectiveness:
  • chloral hydrate (cloral betaine)
  • minocycline
  • probiotics
  • rubefacients
  • silk garments
  • vitamins and minerals.
• Medicines where more cost-effective alternatives were available:
  • alimemazine
  • aliskiren
  • blood glucose testing strips.

(Published February 2020 - Retired July 2026)