Greater Glasgow and Clyde Medicines

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• Generic dapagliflozin is the most cost-effective SGLT2 inhibitor for all licensed indications.
• Where clinically appropriate, clinicians may wish to consider generic dapagliflozin as the preferred cost-effective option when prescribing an SGLT2 inhibitor.
• Clinical choice remains guided by existing CKD, diabetes and heart failure guidelines.
• Patients on SGLT2 inhibitors will be switched to generic dapagliflozin, where clinically appropriate, ensuring patient safety and continuity of care are prioritised throughout the process.

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• From 22nd July 2026 NHSGGC are switching to enoxaparin for treatment LMWH doses in adults due to rising costs of dalteparin. This change has been endorsed by the Acute Services Prescribing Management Group (ASPMG). 

• The GGC Adult Therapeutics Handbook and GGC clinical guidelines are being updated to reflect this. 

• Treatment enoxaparin subcutaneous (SC) dosing is based on thrombosis risk, patient weight and renal impairment – a dose banding table will be available in the Adult Therapeutics Handbook to support this. 

• Take extra care with prescribing in renal impairment and low body weight as these patients may be on a 40mg SC once daily treatment dose of enoxaparin, i.e. a dose commonly used for prophylaxis of venous thromboembolism (VTE). 

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• A new NHSGGC clinical guideline: Cranial Diabetes Insipidus, Inpatient Management is now available on NHSGGC Right Decisions for Health and Care Platform.
• This guideline is aimed at managing adult patients with known cranial diabetes insipidus (DI) who are admitted to general wards. It excludes patients with AVP resistance (Nephrogenic DI); a new diagnosis of cranial DI; patients post pituitary surgery; pregnant or ICU patients.
• All patients with cranial DI should be identified and referred to Endocrine team on admission to hospital and have U&Es monitored frequently.
• Desmopressin must be administered on time and as prescribed and doses MUST NOT be omitted without senior clinical advice. Omission or delay in desmopressin treatment could result in patient harm. 
• In patients with compromised oral route, equivalent doses can be administered via an alternative route and guidance on equivalent doses is provided.
• The guideline also outlines the management of sodium disorders in patients with known cranial DI on desmopressin. 

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• There is a risk that IV gentamicin prescribed 48 hourly may inadvertently be prescribed and/or administered 24 hours earlier than intended. This can lead to gentamicin toxicity, including serious renal impairment/ oto-vestibular toxicity.
• All nursing staff, medical staff and pharmacists should take action to minimise the risks of this happening.

New published chapters: cardiovascular and skin

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• A new regional West of Scotland formulary is being developed, which will replace the NHSGGC formulary over time.
• The May 2026 edition of the regular Formulary Focus newsletter has been issued to keep staff in participating Health Boards up-to-date with progress.
• Excellent progress has been made so far, with Cardiovascular, Gastro-Intestinal, Respiratory and Skin chapters now launched.
• The Skin chapter is the first chapter to offer both adult and paediatric recommendations.

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• When a specialist recommends initiating a new medicine or adjusting existing therapy, written communication should be sent to the GP practice electronically.
• All communications to GP practices regarding medication requests - whether via out-patient letters or the Clinical Portal eForm ‘Request to GP to prescribe medication’ - must clearly indicate if the individual making the request is a prescriber or non-prescriber.
• Increasingly, non-prescribing pharmacy team members are responsible for processing medication requests and outpatient letters, rather than GPs or other prescribers. Therefore, it is crucial that there is sufficient information supplied to ensure timely processing of the request.
• The rationale for the request and indication for the medication should be stated, along with clear details on drug name, dosage, preparation, frequency and duration.
• Non-urgent medication requests will be processed within five working days, in line with pharmacy hub processing times (with an additional two working days for the community pharmacy to dispense). Urgent medication requests (requiring same-day or within 24-hour supply) will be managed through Hospital Pharmacy, HBP prescription pads, or to take out (TTO) medicines.

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• NHSGGC Coronary Heart Disease and Stroke, Primary and Secondary Prevention (cholesterol) Clinical Guideline has been published on the Right Decisions platform.
• This iteration of the guideline (v7) has been extensively updated, with changes to advice around lipid management for both primary and secondary prevention of coronary heart disease and stroke.
• The threshold for initiation of lipid lowering therapy in primary prevention (cardiovascular risk event of 10% or more over ten years) has been reduced from 20%, aligning with contemporary risk calculation tools and national guidelines.
• Indications for statin therapy in patients with diabetes mellitus have been updated to reflect national guidelines.
• Targets for low density lipoprotein and non-high density lipoprotein cholesterol have been revised to align with national guidelines.
• Greater emphasis has been placed on use of ezetimibe to support achievement of low density lipoprotein cholesterol targets in secondary prevention.