Greater Glasgow and Clyde Medicines

Key messages:

• The Valproate Pregnancy Prevention Programme (Prevent) Guide for Healthcare Professionals was updated in January 2024. Refer to Updated Valproate Regulatory Measures.
• MHRA Drug Safety Update September 2024, recommends, as a precaution, that male patients on valproate use effective contraception (condoms, plus contraception used by the female sexual partner) throughout the valproate treatment period and for 3 months after stopping valproate.
• Topiramate is now also contraindicated in pregnancy and in women of childbearing potential unless the conditions of a Pregnancy Prevention Programme are fulfilled. As topiramate is classed as an enzyme-inducer, not all contraceptive methods are suitable.
• This updated blog provides local expert advice to assist decision making on contraceptive methods.

To access the full blog via Microsoft Sway, click here

Key Messages

• The GGC Adult Vancomycin Intermittent Infusion guideline and Prescribing, Administration and Monitoring chart (Vanc-PAM) have been updated.
• The GGC Adult Vancomycin dose calculator has been updated to use adjusted body weight (AdjBW) to calculate the creatinine clearance (CrCl) in patients weighing above their ideal body weight (IBW).

Prescribers should ensure that the Patient Information Leaflet (PIL) (attached to the PAM chart) is issued to the patient/carer as soon as possible. The gentamicin PIL now asks patients to report any pre-existing issues with hearing or balance as well as personal or familial history of mitochondrial disease and any previous hearing or balance issues relating to antibiotics.

Key messages:

• The GGC Creatinine Clearance (CrCl) calculator will now use Adjusted Body Weight (AdjBW) rather than Maximum Body Weight (MBW) to estimate renal function for patients who weigh more than their Ideal Body Weight (IBW).

• AdjBW provides a better estimate of renal function for patients who are overweight or obese.

• AdjBW is IBW plus 40% of the difference between ideal and actual body weight.

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

To access the full blog via Microsoft Sway, click here

The Emergency Care Summary (ECS) for patients with a diagnosis of schizophrenia may show no record of any antipsychotic prescription; this may indicate they are prescribed a specialist medicine such as clozapine or an antipsychotic depot.

To access the full blog via Microsoft Sway, click here

• Serum ferritin (SF) is the most useful test for iron deficiency.
• Serum iron, transferrin levels and transferrin saturation (TSAT) are labile measurements and not reliable indicators of low iron stores. Their role should be limited to investigation of high SF values and possible iron overload.
• Low SF (<15micrograms/L) provides absolute evidence of iron deficiency.
• Ferritin levels can be elevated by inflammatory processes and can mask iron deficiency.
• SF >100micrograms/L generally rules out IDA even in the presence of inflammatory disease.
• If SF results are equivocal, practitioners should consider monitoring the haemoglobin (Hb) concentration in response to a trial of oral iron.