NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines

Medicines Update Extra

MU Extra provides a summary of the evidence base for medicines and therapies. It gives a ready reference for busy health professionals

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 Content is less than 2 years old and is valid, however, prescribing information can change. Refer to the latest version of the manufacturer's summary of product characteristics (SPC) at http://emc.medicines.org.uk.

 Content is more than 2 years old, however the recommendations are still valid in NHSGG&C. Please note, prescribing information can change. Refer to the latest version of the manufacturer's summary of product characteristics (SPC) at http://emc.medicines.org.uk.

 Withdrawn as more than 2 years old and content no longer valid.  Contact Medicines Information (0141 211 4407) for further advice.

MUE 06: Oral NSAIDs - An Update

Posted: August 25, 2017.
Category - Medicines Update Extra

 

 Oral NSAIDs - An Update

** This bulletin supersedes PostScript Extra No. 24 **

  • There is considerable variation in individual response and tolerance to NSAIDs, but little difference in anti-inflammatory activity.
  • All NSAIDs should be avoided if possible in patients with a history of vascular disease, a high risk of cardiovascular disease (CVD), or gastrointestinal (GI) risk factors.
  • Treatment choice depends on individual response, risk factors and adverse effects, particularly GI and cardiovascular (CV) complications.
  • The lowest effective dose to control the patient’s symptoms, for the shortest duration possible, should be used. The use of ‘as required’ NSAIDs should be considered where appropriate.
  • The preferred non-selective NSAIDs are ibuprofen or naproxen. A proton pump inhibitor (PPI) may be required depending on GI risk.


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MUE 05: DOAC Prescribing

Posted: February 20, 2017.
Category - Medicines Update Extra
Tagged with - Anticoagulants DOACS

 DOAC Prescribing in Patients with Non-Valvular AF and for the Treatment and Prevention of VTE

** This bulletin supersedes “NOAC Prescribing in Patients with Non-Valvular Atrial Fibrillation, Frequently Asked Questions, Feb 2015” **

The FAQ includes:

  • Questions relating to indications/appropriateness of DOACs
  • Questions relating to choice of DOAC & dose
  • Questions relating to DOAC initiation
  • Further information and advice
  • Decision making algorithms

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MUE 04: PPIs

Posted: December 18, 2015.
Category - Medicines Update Extra

 Oral Proton Pump Inhibitors

  • Proton Pump Inhibitors (PPIs) are one of the most commonly prescribed classes of drug
  • PPIs are an effective treatment when used appropriately
  • PPIs should only be prescribed where there is a clear indication
  • PPIs are usually well tolerated
  • Recent evidence suggests that PPIs may have potentially serious adverse effects such as fractures, hypomagnesaemia, subacute cutaneous lupus erythematosus, pneumonia and Clostridium difficile infection

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MUE 03: Management of Urinary Incontinence and Overactive Bladder

Posted: November 09, 2015.
Category - Medicines Update Extra

 Management of Urinary Incontinence and Overactive Bladder

  • Lifestyle interventions and non-pharmacological strategies should be tried as first-line treatment.
  • If pharmacological therapy is indicated, antimuscarinics should be tried first line.
  • Immediate release (IR) oxybutynin, IR and modified release (MR) tolterodine and solifenacin are on the Preferred List of the Formulary.
  • IR oxybutynin and IR tolterodine are significantly less expensive than other preparations on the Formulary, however, they may have less tolerability.
  • MR tolterodine has similar efficacy and tolerability to solifenacin but is significantly less expensive, therefore, consider prescribing MR tolterodine prior to solifenacin.
  • Patients should be reviewed 4 weeks after starting each new therapy and after a dose change.
  • Patients on long term therapy should be reviewed annually or every 6 months if over 75 years.

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MUE 02: Drug induced QT prolongation

Posted: April 22, 2015.
Category - Medicines Update Extra

   Drug induced QT prolongation

** This bulletin supersedes PostScript Extra No. 21 **

  • Prolongation of the QT interval can lead to a life threatening arrhythmia known as torsades de pointes
  • In the last few years a number of warnings have highlighted the risk of QT prolongation with citalopram, domperidone and ondansetron
  • Extra vigilance is required by healthcare professionals to be alert to the risk of drug induced QT prolongation and drug interactions

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MUE 01: Parkinson's disease in acute

Posted: October 31, 2014.
Category - Medicines Update Extra

 Parkinson's disease in acute care

  • It is CRUCIAL NOT TO STOP Parkinson’s Disease (PD) drugs for any significant length of time as there is a risk of Neuroleptic Malignant Like Syndrome (Parkinsonism Hyperpyrexia Syndrome) which may be fatal, as well as causing significant exacerbation of symptoms and patient distress.
  • Where a patient does not have an individual supply of medicine, access should be made via the pharmacy/ Out of hours pharmacist/ local main holding areas of PD medications across NHSGGC. See Staffnet - clinical guideline electronic resource directory, Central Nervous System, search for Parkinson's Disease Medication Stocklist, Acute Hospitals
  • “NIL BY MOUTH” patients-alternative routes need to be considered as appropriate. Seek advice from a PD specialist, clinical pharmacist, or medicines information. Refer to NHSGGC PD nil by mouth guidance when PD specialists are unavailable e.g. out of hours
  • Ensure early referral to the local PD team so medicine administration problems can be prevented before missed doses occur.

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23: Type 2 Diabetes

Posted: December 06, 2013.
Category - Medicines Update Extra

Pharmacological management of adult patients with type 2 diabetes

 Withdrawn as more than 2 years old and content no longer valid.  Contact Medicines Information (0141 211 4407) for further advice.

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20: New Oral Anticoagulants (summary)

Posted: October 19, 2012.
Category - Medicines Update Extra
Tagged with - Anticoagulants

 

An abbreviated summary of PostScript Extra 20: New Oral Anticoagulants

 Withdrawn as more than 2 years old and content no longer valid.  Contact Medicines Information (0141 211 4407) for further advice.

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20: New Oral Anticoagulants

Posted: October 19, 2012.
Category - Medicines Update Extra
Tagged with - Anticoagulants

 

New Oral Anticoagulants

 Withdrawn as more than 2 years old and content no longer valid.  Contact Medicines Information (0141 211 4407) for further advice.

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19: Clopidogrel and PPIs

Posted: November 04, 2011.
Category - Medicines Update Extra

 

Clopidogrel and Possible Interaction with Proton Pump Inhibitors

  • It is still not clear whether there is definitely a clinically relevant interaction between PPIs and clopidogrel as
    available data are conflicting.
  • Although there is extrapolation from in vitro studies that some PPIs may be less likely to interact with
    clopidogrel there does not appear to be any evidence from clinical practice that any one PPI is better than
    another in this respect.
  • Prescribers should consider the risk of GI side effects versus the risk of adverse cardiac events when
    considering co-prescription of a PPI and clopidogrel.

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