Greater Glasgow and Clyde Medicines

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• The NHSGGC Heparin Dose Adjustment in the Presence of Renal Impairment guideline has been updated.
• The updated NHSGGC guideline includes:
• Updated advice for thromboprophylaxis and monitoring requirements in patients with creatinine clearance (CrCl) <15mL/min.
• Updated advice for therapeutic heparin dosing for patients with CrCl <15mL/min.
• Updated guidance for anticoagulation during haemodialysis.

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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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• Most patients with Hepatitis C Virus (HCV) will be treated with oral direct-acting antiviral agents (DAAs) for 8-12 weeks.
• DAAs should be continued during the hospital stay, unless the clinical condition of the patient precludes administration.
• Check for drug interactions with any new medicines; a useful source is www.hep-druginteractions.org.
• The HCV pharmacy team (see contact details in blog) can confirm the patient’s current regimen and provide clinical advice on safe/effective use of DAAs.
• Where available, use the patient’s own drugs (PODs). See ‘Administration and supply’ section for the process to follow if PODs are not available.
• At discharge, if the DAA regimen is dispensed in the community, contact the patient’s community pharmacy to ask them to resume supply.

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• All teams involved in the care of patients prescribed apremilast including specialist services, GP practices, and community pharmacies need to be aware of recent changes in supply arrangement. Prescribing and supply are moving from primary care to hospital Homecare Services following changes to pricing and supply arrangements. 

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• Proxor® metered dose inhaler (MDI) is now the first line ICS+LABA metered dose inhaler option within NHSGGC, in line with the West of Scotland Formulary.
• Proxor® MDI should be preferred choice for patients newly initiated on beclometasone/formoterol.
• Patients currently prescribed other beclometasone/formoterol MDIs may be reviewed and switched where clinically appropriate.
• This change is safe, cost-effective, and supported across NHSGGC.

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• The NHSGGC DOAC Patient Information Booklet and Alert Card have been updated with minor changes to the content (summarised in blog).
• The booklet contains key safety messages for patients taking a DOAC and is intended to reinforce verbal counselling.
• Electronic copies of the DOAC Patient Information Booklet and Alert Card are available. Printed copies can be ordered by NHSGGC staff (details here).
• Resources are also available from DOAC manufacturers that contain more detailed information and are specific to drug and indication. These can be found by searching electronic medicines compendium (emc) for the DOAC and selecting ‘Risk Materials'.
• An anonymous feedback survey is available for healthcare professionals and patients. Patients should be encouraged to provide feedback to inform any changes to future content.

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• The first chapters of the new regional formulary – Respiratory and Gastro-Intestinal – were launched on Wednesday 15th April. 

• The new formulary website is now live at formulary.nhs.scot/west. An 'NHS Scotland Formulary' mobile app also provides access to the new regional formulary. It can be downloaded by searching for 'NHS Scotland Formulary' in the Apple or Google Play app stores. 

• The existing NHSGGC formulary and associated website will remain operational for chapters not yet included in the regional formulary. A hyperlink to the new website will be included for chapters that have migrated. 

• The new regional formulary presents recommendations using a condition‑based pathway structure, moving away from the traditional BNF‑style list format previously used in the NHSGGC medicines formulary. 

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