Greater Glasgow and Clyde Medicines

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• GMAWS is effective in managing alcohol withdrawal syndrome (AWS).
• The 2025 revised guidance allows easier estimation of alcohol units consumed.
• The Fast Alcohol Screening Tool (FAST) score is used to assess use disorder: a score of 5 or more suggests alcohol dependency.
• Prevention and treatment of Wernicke’s encephalopathy refers to ‘Vitamins B&C solution’ for intravenous infusion. Pabrinex® is no longer routinely available.
• The treatment of those at risk of Wernicke’s encephalopathy has been simplified.
• Oral thiamine should be continued for at least 6 weeks after becoming abstinent and having established a satisfactory diet. At that point thiamine discontinuation should be considered.
• Senior medical review of diagnosis and the need for possible adjunctive therapy if the patient:
• requires more than 120mg diazepam (or 12mg lorazepam) in 24 hours or
• is requiring full dose treatment 96 hours after last alcohol ingestion.
• Alterations to AWS treatment for patients with liver disease have been more clearly defined (see further details in Background section):
• All patients with evidence of advanced liver disease (cirrhosis) use symptom triggered treatment only.
• Patients with evidence of advanced liver disease and liver dysfunction: jaundice (bilirubin >80micromol/l), coagulopathy (INR/Prothrombin time ratio >1.5) or history of hepatic encephalopathy: use symptom triggered lorazepam: 1mg-2mg.

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• Cardiovascular diseases cause more than a quarter of all deaths in Scotland, the second most common cause of death after cancer.

• The Cardiovascular Risk Factors Programme, launched in April 2025, aims to address this challenge with the goal of reducing avoidable premature CVD deaths by 20% in 20 years.

• To support implementation of the programme a 'National cardiovascular disease (CVD) prevention and risk factors toolkit' has been created on the Right Decision Service website.
  

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• Mixing polyethylene glycol/macrogol laxatives (e.g. Laxido®, Movicol®) with starch-based thickeners (see table in blog) poses a risk to patients with dysphagia.
• Combining the two compounds results in a thinner, watery fluid, increasing the risk of aspiration.
• Action is required to ensure that patients are not using a starch-based thickener in combination with a macrogol laxative (see recommendations in blog).
• The current preferred list first line thickening product in NHSGGC is xanthan gum-based Nutilis® Clear which can be used with macrogol laxatives.

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This post summarises the latest NHS Greater Glasgow and Clyde decisions relating to new medicines assessed by SMC and considered by the Area Drug and Therapeutics Committee (ADTC) and uses a nationally developed format specifically aimed for patients and the public.

For full details of the medicines included in this post that are available for use, including any restrictions on prescribing, please see the relevant entry in the GGC Formulary.

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The emollients section of the NHSGGC Adult Medicines Formulary has been updated in line with recommendations from a SLWG of dermatologists, GPs, specialist nurses and pharmacists.

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• Alfentanil is an injectable strong opioid, which is 30 times more potent than oral morphine.
• It should only be used following specialist advice and is considered 3rd line for pain unresponsive to other opioids (see below for further guidance).
• A NHSGGC 8-minute video (NHSGGC network access required), on how to safely prescribe alfentanil in the Acute Sector, is available.
• There are many potential risks associated with prescribing and administering alfentanil, e.g. wide dose range and availability of more than one strength of injection.
• It is important to follow the good practice points outlined below.