Greater Glasgow and Clyde Medicines

Generic prescribing is usually recommended for a number of reasons including cost-effectiveness, reduction in prescribing and dispensing errors and reducing risk of supply problems. However, in certain circumstances it is important to prescribe medication by brand name.

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Key Messages

• Scottish Government consensus statement removes the need for GLP1 medications (Glucagon-like peptide-1 receptor agonists (GLP1-RAs) and GLP1-RAs/Glucagon-dependent insulinotropic polypeptide receptor agonists (GIP-RAs)) for weight management to be supplied through a specialist weight management service providing that appropriate lifestyle and dietary advice can be given to the patient.
• Consensus statement also allows for Health Boards to identify priority groups for treatment, commencing with those with a higher BMI plus co-morbidities.
• There is a requirement to identify a prescribing pathway to complement the lifestyle and dietary advice provided by GGC Weight Management Service.
• NHSGGC Area Drug and Therapeutics Committee (ADTC) have supported the consensus statement though both semaglutide (Wegovy®) (GLP1-RA) and tirzepatide (Mounjaro®) (GLP1/GIP-RA) remain non-formulary pending an agreed prescribing pathway.
• Prescribers are requested not to prescribe these drugs for weight management until an agreed pathway has been developed and implemented and they have been added to the NHSGGC Adult Medicines Formulary.

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Key messages

• Quick access to chemoprophylaxis for close contacts is critical.
• Parents/carers and siblings at the bedside of a patient need rapid and easy access to chemoprophylaxis managed within the hospital.
• Pre-labelled patient packs, available via acute site emergency stock locations, should be used for bedside carers and siblings.
• If pre-labelled patient packs are not available, a Hospital “Day Care Prescription form” can be used to prescribe and dispense chemoprophylaxis.
• NHSGGC clinical guideline provides information for prescribing and supply during in and out of hours period.

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The NHSGGC MI enquiry service provides evidence based information and advice to support safe and effective prescribing. The advice is provided in response to specific enquiries and is tailored to individual patients, while taking account of the NHSGGC Formulary and prescribing guidelines.

In addition to the enquiry service, MI also leads on a number of other services and resources including the Adult Therapeutics Handbook, the NHSGGC Formulary, and the Medicines Update blogs.

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This is the first in a series of blogs on overprescribing with future focuses on inappropriate polypharmacy, transitions of care, data and digital, and non-pharmacological choices.

It is part of a wider public campaign launched by NHSGGC, aiming to reduce medicines waste by sharing information and advice with staff, patients and members of the public.

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.

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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.