Greater Glasgow and Clyde Medicines

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• Covert medication is the administration of any medical treatment in disguised form. Therefore, an injectable medication or patch cannot be ‘covert’. The most common way is via liquid or food stuff.

• Covert medication must never be given to someone who is capable of deciding about their medical treatment. It is an option for patients who lack capacity and are unwilling to take essential medication. Patients’ wishes should be considered, ideally consulting others who know them well.

• It must be of benefit and the least restrictive option. It’s an alternative to more distressing methods of giving medication, for example intramuscular injections.

• A pharmacist must be consulted to provide specialist advice on mixing medication with foodstuffs. Altering the form of a medication is unlicensed and could result in harm - see NHSGGC Safe and Cost-Effective Administration for Covert Medication and in Dysphagia.

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Adding “outside” medicines (those prescribed and supplied outside the practice) to patient prescriptions will result in:

• Safer prescribing: prescription record is complete, allowing GP practice clinical decision support to flag drug interactions.
• Increased patient safety: these medicines appear in the Emergency Care Summary (ECS).
• Improved medicines reconciliation: due to more complete record of prescribing in ECS.

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• Some medicines include ingredients derived from peanuts or soya. These components are refined to remove allergy-causing proteins, substantially reducing the risk of an allergic reaction. As a precaution, the Medicines and Healthcare products Regulatory Agency (MHRA) contraindicates their use in patients with peanut or soya allergies.
• It is vital that patient records clearly document all allergies to foods and medicines.
• Although a reaction is highly unlikely, patients with allergies to peanut and/or soya should be counselled on the importance of checking up-to-date product information for all prescribed and purchased medicines, as ingredients can be subject to change.

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• NHSGGC Clinical Guidelines for Antiplatelet Therapy Prescribing in the Secondary Prevention of Coronary Artery Disease (version 3) and Antiplatelet Therapy in Secondary Prevention of Stroke and TIA (version 6) are live on the Right Decisions for Health and Care platform.
• Both guidelines are aimed at prescribers working in acute and/or primary care settings and are intended to guide optimal prescribing of antiplatelet therapy in patients with established vascular disease.
• The predominant change in management of coronary artery disease is the use of aspirin and prasugrel as the dual antiplatelet therapy (DAPT) regimen of choice in patients undergoing percutaneous coronary intervention (PCI).
• The salient update in the cerebrovascular guideline is use of 21 days DAPT with aspirin and clopidogrel in people with non-cardioembolic minor ischaemic stroke, or high-risk transient ischaemic attack in the past 24 hours, if the diagnosis has been confirmed by a stroke specialist and brain imaging has excluded intracranial haemorrhage.
• The guidelines also make key recommendations around prescribing of single or DAPT in patients, with and without an indication for concurrent oral anticoagulant (OAC) therapy.

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.